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Civic Medical Centre Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 7 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Civic Medical Centre on 19 January 2017. The overall rating for the practice was inadequate and the practice was placed in special measures for a period of six months. The full comprehensive report on the January 2017 inspection can be found by selecting the ‘all reports’ link for Civic Medical Centre on our website at www.cqc.org.uk.

This inspection was undertaken following the period of special measures and was an announced comprehensive inspection on 5 September 2017. Overall the practice is now rated as requires improvement.

Our key findings were as follows:

  • The practice had addressed the matters that led to breaches in regulations at our last inspection, with the exception of addressing infection prevention and control risks.

  • 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.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Feedback about patient experiences, from national GP patient survey, suggested the practice performance had improved from the previous year in many areas

  • Information about services and how to complain was available and easy to understand.

However, there were also areas of practice where the provider needs to make improvements.

The areas where the provider must make improvements are:

  • Ensure care and treatment is provided in a safe way to patients.
  • Explore ways of improving the accessibility of the practice premises

In addition the provider should:

  • Ensure they complete the remedial actions identified in their most recent infection prevention and control audit
  • Continue to explore ways to improve the identification of a greater proportion of patients with caring responsibilities so they can provide and signpost them to appropriate support
  • Explore ways of improving access to appointments

I am taking this service out of special measures. This recognises the improvements made to the quality of care provided by the service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety, with the exception of those in respect of infection prevention and control and medicines management.

  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 7 December 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were in line with the national average.

  • Staff were aware of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of supervision, appraisals and personal development plans for all staff.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 7 December 2017

The practice is rated as good for providing caring services.

  • Results from the national GP patient survey, which had improved from the previous year, showed patients rated the practice in line with local and national averages for several aspects of care.

  • Patient feedback we received indicated that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. They recognised that diabetes and hypertension were particularly prevalent among their practice population, and provided targeted support through clinical reviews and on-going monitoring of these patients.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • Urgent appointments were available on the same day.

  • Information about how to complain was available and evidence from two examples we reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.

  • The practice premises and facilities was not conveniently accessible to wheelchair users

  • The practice was rated lower than lower than local and national averages for how conveniently patients could access care and treatments.
  • Patients we spoke with said they were able to make an appointment when they needed, although a few comments cards we received provided mixed feedback which largely related to difficulty getting a convenient appointment or getting through to the practice by phone.

Well-led

Good

Updated 7 December 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.

  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour, and we saw evidence the practice complied with these requirements.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.

  • The practice proactively sought feedback from staff and patients. The practice engaged with the patient participation group.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority.

  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.  

Checks on specific services

Older people

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for the care of older people. The practice was rated as requires improvement for being safe and for being responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

  • 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. Regular medication reviews and care plans are completed for the patients belonging to this group

  • The practice was responsive to the needs of older patients, and offered home visits, arranged domiciliary phlebotomy as required

  • The practice nurse visited housebound patients to administer flu and pneumonia vaccinations in the winter season

  • Urgent appointments were available 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.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • The practice attended multi – disciplinary group meetings where care discussions are discussed.

People with long term conditions

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The practice was rated as requires improvement for being safe and for being responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

  • The practice maintained clinical registers of their patients with long term conditions including diabetes, chronic obstructive pulmonary disease (COPD), asthma, heart problems, thyroid disorders, hypertension, cancer, arthritis and stroke.All patients within these groups were routinely invited to the practice for appropriate consultations, including treatment by intervention or education.

  • They had set up a dedicated diabetes clinic to support patients with this condition, as it had been identified as the most prevalent long term condition among patients in their practice population

  • The practice performance against Quality and Outcomes framework (QOF) clinical targets was in line with national averages.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • 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.

Families, children and young people

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for the care of families, children and young people. The practice was rated as requires improvement for being safe and for being responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

  • From the sample of documented examples we reviewed we found there were systems 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.

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

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

  • The practice worked with midwives and health visitors to support this population group; for example, in the provision of ante-natal, post-natal and child health surveillance clinics.

  • Immunisation rates were in line with national targets for all four standard childhood immunisations.

  • Baby changing facilities were available in the practice premises

  • The staff told us they could provide a room for patients needing to breastfeed in private

  • All staff had received training in safeguarding children and adults from abuse, and knew how to recognise and escalate any safeguarding concerns

  • Clinical staff had received awareness training in female genital mutilation (FGM), and understood how to treat and support these patients or patients at risk, and report any concerns or cases to relevant authorities

  • The practice proactively sought to identify patients with caring responsibilities, and new patients were asked about this as part of their registration process. Carers were referred to local support organisations

Working age people (including those recently retired and students)

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and students). The practice was rated as requires improvement for being safe and for being responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

  • 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, and extended opening hours.

  • 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.

People whose circumstances may make them vulnerable

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The practice was rated as requires improvement for being safe and for being responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, people affected by drug / alcohol abuse, domestic violence, sexual exploitation, carers 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.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 7 December 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health (including people with dementia). The practice was rated as requires improvement for being safe and for being responsive. The concerns which led to these ratings apply to everyone using the practice, including this population group.

  • The practice carried out advance care planning for patients living with dementia.

  • 89% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

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

  • Patients at risk of dementia were identified and offered an assessment.

  • 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.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.