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Inspection Summary


Overall summary & rating

Good

Updated 7 December 2017

Letter from the Chief Inspector of General Practice


This practice is rated as Good overall. (Previous inspection 8 April 2015 – Good)

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

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Ribbleton Medical Centre on 2 November 2017 as part of our inspection programme to inspect 10% of practices before April 2018 that were rated Good in our previous 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 evidence that incidents were not always shared effectively with staff and the practice was working to improve this.

  • The practice conducted safety risk assessments and staff recruitment processes were comprehensive. However, there were no occupational health checks undertaken for new staff to assess that working conditions were appropriate. Staff told us that these would be introduced in the future.

  • 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.

  • When GPs were very busy, they asked staff to work to a practice protocol to process some normal patient test results without sight of a GP. This protocol was comprehensive but there was no audit of its use to ensure that it was followed correctly.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • When patients reported problems in accessing the appointment system the practice worked to resolve these and had introduced a new telephone system. They had recruited an advanced nurse practitioner to improve access to clinicians from January 2018.

  • There was a proactive approach to managing the skill mix of staff needed to provide best care to patients. Staff felt respected, valued and supported.

  • Quality improvement issues were discussed in regular staff meetings. Clinical matters were discussed in weekly meetings although there were no formal minutes kept for these meetings.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

The areas where the provider should make improvements are:

  • Continue to develop a system to allow better communication of safety incidents to all staff and to record and share clinical discussion.

  • Introduce occupational health screening for new staff to assess whether working conditions are appropriate.

  • Introduce an audit process to ensure that the practice protocol for staff filing patient test results has been followed correctly.

  • Take steps to better identify patients on the practice list who are also carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 December 2017

Effective

Good

Updated 7 December 2017

Caring

Good

Updated 7 December 2017

Responsive

Good

Updated 7 December 2017

Well-led

Good

Updated 7 December 2017

Checks on specific services

Older people

Good

Updated 8 May 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. For example the Quality and Outcomes Framework (QOF) information indicated the percentage of patients aged 65 and older who had received a seasonal flu vaccination reflected the national average. The practice safeguarded older vulnerable patients from the risk of harm or abuse. There were policies in place, staff had been trained and were knowledgeable regarding vulnerable older people and how to safeguard them. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. One GP had protected time specifically to focus on the health needs of people living in care homes within the local community.

People with long term conditions

Good

Updated 8 May 2015

The practice is rated as good for the care of people with long-term conditions. The practice had a higher than average number of patients with long standing health conditions compared to the local Clinical Commissioning Group (CCG) area. Patients with long term conditions were supported by a healthcare team that cared for them using good practice guidelines and were attentive to their changing needs. Patients had health reviews at regular intervals depending on their health needs and condition. Patients who did not respond to their annual invite to review their healthcare condition were offered a telephone consultation with a GP. The practice maintained and monitored registers of patients with long term conditions including cardiovascular disease and diabetes. These registers enabled the practice to monitor and review patients with long term conditions effectively. The Quality and Outcomes Framework (QOF) information indicated that patients with long term health conditions received care and treatment in line with national averages. One of the homes visited regularly by the GP with protected time catered for patients with brain damage and therefore tended to be a younger age group.

Families, children and young people

Good

Updated 8 May 2015

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

Staff demonstrated a good understanding and were proactive in safeguarding and protecting children from the risk of harm or abuse. The practice had a clear means of identifying in records those children (together with their parents and siblings) who were subject to a child protection plan. The practice had appropriate child protection policies in place to support staff and staff were trained to a level relevant to their role. The practice offered a full range of childhood vaccinations and had systems in place to follow up children who did not attend for these.

Working age people (including those recently retired and students)

Good

Updated 8 May 2015

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, flexible and offered continuity of care. 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

Good

Updated 8 May 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice was aware of, and identified their vulnerable patients. This was highlighted within patient records. The practice discussed any concerning patients as a team, safeguarding policies and protocols were in place and staff were trained in safeguarding vulnerable adults and children. The safeguarding lead was a GP who had received appropriate training. The practice held a register of patients living in vulnerable circumstances including those with a learning disability. They carried out annual health checks for people with a learning disability and offered longer appointments and offered home visits if required.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients who experienced poor mental health. The register supported clinical staff to offer patients an annual appointment for a health check and a medication review. The practice monitored patients with poor mental health according to clinical quality indicators and in line with good practice guidelines. A psychologist worked at the practice one day per week and offered referred patients cognitive behavioural therapy (CBT) which is a talking therapy commonly used to treat anxiety and depression. The practice worked with multi-disciplinary teams and other mental health services in the case management of patients experiencing poor mental health, including those with dementia.