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Wearside Medical Practice Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 1 January 2018

Letter from the Chief Inspector of General Practice

This practice is rated requires improvement overall. We have limited this rating, in line with our principles of aggregation, because there is an underlying rating of inadequate in one of the key questions.

The key question we inspected is rated as:

Are services well-led? - Inadequate

We first carried out an announced comprehensive inspection of this practice on 31 August 2016. We rated the practice then as good overall and requiring improvement for providing well-led care. This was because although the practice had some governance arrangements in place, there were areas that needed improvement.

We carried out this announced focused inspection at Wearside Medical Practice on 6 November 2017 to check whether the practice had followed their action plan and taken steps to comply with legal requirements. The practice had submitted an action plan, which showed they planned to address the concerns by 31 March 2017. This inspection focused on the key question – is the practice well led.

We rated the practice as requires improvement overall.

At this inspection we found:

  • The lack of leadership and oversight in the practice resulted in ineffective systems to identify and proactively manage risks, issues and performance.
  • There was a lack of shared vision within the partnership. The practice did not have effective strategies in place to make sustainable improvements.
  • The practice overarching governance framework was not effective and did not support the practice to identify and act upon areas for improvement. The practice had not made sufficient improvements in many of the areas identified by CQC previously. This included their approach to audit, the process for reviewing and updating policies and procedures, organisation of staff records and the process for reviewing trends and themes of significant events.
  • Improvement was not a priority among staff and leaders.

At the 31 August 2016 inspection, we said the practice should ensure there were systems and processes in place to identify and meet the needs of carers. In November 2017, we found the number of carers had increased from 0.4% (29 carers) to 0.6% (46 carers). However, this was still lower than expected given the demongraphics of the practice population. The 2011 census data for the local authority area indicated that 11.8% of patients provided some level of unpaid care.

The areas where the provider must make improvements as they are in breach of regulations are:

  • Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

The areas where the provider should make improvements are:

  • Ensure there are systems and processes in place to identify and meet the needs of carers.

Where a service is rated as inadequate for one of the five key questions or one of the six population groups, it will be re-inspected within six months after the report is published. If, after re-inspection, the service has failed to make sufficient improvement, and is still rated as inadequate for any key question or population group or overall, we will place the service into special measures. Being placed into special measures represents a decision by CQC that a service has to improve within six months to avoid CQC taking steps to cancel the provider’s registration.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. However, there was no process in place to review incidents over a period of time to identify trends and themes.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients 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 in place to keep patients safe and safeguarded from abuse. However, we found staff personnel records were disorganised and it was difficult to find information relevant to a staff members.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 7 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were below average when compared to the local clinical commissioning group (CCG) and national averages. Nationally reported data taken from the Quality Outcomes Framework (QOF) for 2014/15 showed the practice had achieved 82.4% of the points available to them for providing recommended treatments for the most commonly found clinical conditions. This was much lower than the national average of 94.8% and the CCG average of 95.7%. The practice recognised that staffing had previously impacted on performance across a number of areas, and they provided unverified data for 2015-16, which demonstrated some improvement.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement. However, the selections of topics for audit were generated by individual clinician areas of interest and the practice had not considered how they could use audit to support them to improve as a practice.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of 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.

Caring

Good

Updated 7 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed although the majority of patients felt they were treated with compassion, dignity and respect, scores were variable, with some below average.
  • 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 easy to understand and accessible.
  • The practice had identified 0.4% of their patient list as carers. They planned to improve the service offered to carers, by introducing annual health checks.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 7 November 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice was part of the local initiative to deliver support to patients in care homes through local integrated teams.
  • Patients told us of recent difficulty in making appointments. We found the practice had kept patients informed of recent staffing difficulties and had taken action to recruit clinical staff. The practice offered extended hours every working day and urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. However, the practice could make more use of audit and quality improvement techniques to ensure they extracted all learning from complaints.

Well-led

Inadequate

Updated 1 January 2018

Checks on specific services

Older people

Good

Updated 7 November 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 people in its population. For example, all patients over the age of 75 had a named GP. Patients at high risk of hospital admission and those in vulnerable circumstances had care plans.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • A palliative care register was maintained and the practice offered immunisations for pneumonia and shingles to older people.

People with long term conditions

Requires improvement

Updated 7 November 2016

The practice is rated as requiring improvement for the care of patients with long-term conditions.

  • The practice had lower performance on a number of indicators within the Quality Outcomes Framework (QOF) for 2014/15, when compared to local and national averages. Overall the practice had achieved 82.4% of the points available to them for providing recommended treatments for the most commonly found clinical conditions. This was much lower than the national average of 94.8 and the local clinical commissioning group (CCG) average of 95.7%. The practice achieved lower performance on groups of indicators relating to long-term conditions such as diabetes, asthma and hypertension. For example, the practice achieved 72.4% of the points available for diabetes related indicators. This compared to an average performance of 93.5% across the CCG and 89.2% national average. The practice provided unverified data for 2016-17 which showed some level of improvement.
  • Nursing staff had lead roles in chronic disease management and patients at risk of admission to hospital were identified as a priority.
  • Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively.
  • Patients had regular reviews to check health and medicines needs were being met.
  • For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 7 November 2016

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

  • The practice had identified the needs of families, children and young people, and put plans in place to meet them.
  • 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.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice’s uptake for the cervical screening programme was 82.4%, which was slightly higher than the CCG average of 81.7% and national average of 81.8%.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.

Working age people (including those recently retired and students)

Good

Updated 7 November 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 and the practice had adjusted the services it offered to ensure these were accessible and flexible. Extended hours surgeries were offered each weekday from 7am for working patients who could not attend during normal opening hours.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group. Patients could order repeat prescriptions and book appointments on-line.
  • Additional services were provided such as health checks for the over 40s and travel vaccinations.

People whose circumstances may make them vulnerable

Good

Updated 7 November 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 those with a learning disability.
  • Patients with learning disabilities were invited to attend the practice for annual health checks and were offered longer appointments, if required.
  • The practice had effective working relationships with multi-disciplinary teams in the case management of vulnerable people.
  • 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 agencies in and out of hours.
  • The practice had systems in place for identifying carers. They planned to ensure carers were offered a health check and referred for a carer’s assessment.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 November 2016

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

  • The practice had identified 0.8% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services.
  • The practice worked closely with multi-disciplinary teams in the case management of people experiencing poor mental health including those with dementia. Care plans were in place for patients with dementia.
  • Patients experiencing poor mental health were sign posted to various support groups and third sector organisations.
  • The practice kept a register of patients with mental health needs which was used to ensure they received relevant checks and tests.
  • They had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support people with mental health needs and dementia. The practice carried out advance care planning for patients with dementia.