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Inspection Summary


Overall summary & rating

Good

Updated 2 May 2018

This practice is rated as Good overall. (Previous inspection was in March 2015 and was rated as 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 Middleway Surgery on 22 March 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.
  • 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 with many examples shared of career development.
  • There were high levels of staff satisfaction. Staff were proud of the organisation as a place to work and spoke highly of the culture. This had led to a happy, loyal workforce with low staff turnover. The practice welcomed nursing students, and medical students.

There was one area where the provider should make an improvement

  • The practice should continue to monitor and improve how patients could access care and treatment


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 May 2018

Effective

Good

Updated 2 May 2018

Caring

Good

Updated 2 May 2018

Responsive

Good

Updated 2 May 2018

Well-led

Good

Updated 2 May 2018

Checks on specific services

Older people

Good

Updated 8 May 2015

The practice is rated as good for providing care to older people.

This population group formed a significant percentage of the total number of patients at the practice. 45% of the 6,350 patient population were over 65 years of age. There were four residential care homes in the area, including a nursing home. GPs at the practice worked closely with these services.

The practice GPs provided regular visits to patients in the nursing and residential care homes. Every patient was reviewed annually as part of the practice policy on nursing home reviews.

The practice had regular liaison with a community matron who was responsible for looking after some of the older and most vulnerable patients, providing extra support where needed. The practice and the community matron met up regularly to discuss cases and ensure continuity of care.

The practice held monthly multi-disciplinary meetings to discuss patients at risk of unplanned hospital admissions. This enabled patient’s care plans to be reviewed to ensure that safe and appropriate care was being provided.

The practice also discussed any patients that were classed as vulnerable and any adult safeguarding concerns. In order to fully support patients, there was a a system in place which ensured that any carer’s details were recorded on the patient’s records.

People with long term conditions

Good

Updated 8 May 2015

The practice is rated as good for providing care to people with long term conditions.

The practice had a significant number of patients who were suffering from long term conditions. The two practice Nurses carried out regular reviews of all patients in this population group. Patients received a letter of invitation when their annual health check was due, or more frequently if appropriate

The practice ensured that each patient was sent at least three reminders to attend the health check. GPs were made aware of any patients who have not responded after these reminders so that appropriate follow up action could be taken. This included phone calls by the GP.

Patients with long term conditions were able to request their repeat medications via email as well as more traditional methods. The practice offered electronic transfer of prescriptions so that patients did not have to attend the practice in order to collect their prescriptions.

The practice held regular clinics for patients in this population group. For example, warfarin clinics at the practice provided “in-house” testing so that patients were provided with instant results. In this way, the practice was able to provide patients with a new prescription or update their treatment the same day.

Families, children and young people

Good

Updated 8 May 2015

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

Practice nurses carried out regular immunisation and vaccination programmes. Practice GPs provided 24 hour baby checks. They also carried out baby checks when new babies reached the eight week old stage. The practice acted on feedback to not hold specific baby clinics as it was suggested that families should be able to attend at a time to suit them.

The practice had a child friendly waiting room with toys which were easy to keep clean. There was also a wide range of educational health leaflets for parents. All staff we spoke with were aware of child safeguarding procedures and the practice held regular safeguarding meetings with the health visitor and midwife.

Details of children’s attendance at A&E were routinely copied to the health visitor for review and if necessary discussed at GP meetings.

The practice had effective liaison with the local midwife. The midwife held their clinics at the practice following feedback that this was more convenient for expectant mothers, rather than attending the local hospital.

Information relevant to young patients was displayed and health checks and advice on sexual health for men, women and young people included a range of contraception services and sexual health screening. This included chlamydia testing and cervical screening.

Working age people (including those recently retired and students)

Good

Updated 8 May 2015

The practice is rated as good for providing care to working age people.

The practice had taken on board feedback from patients which recognised that patients who worked or were in education found it difficult to access the practice in the traditional ways. As a result the practice offered patients the ability to book their appointments via the internet, request prescriptions electronically and the ability to book telephone consultations at a pre-arranged time.

The practice also held appointments later in the evening three days a week which enabled patients to attend outside of normal working hours.

The practice had considered this population group when they arranged for the “Stop Smoking” advisor to hold clinics at the practice itself rather than locations elsewhere. Patients had responded positively to this and stated that it made access easier.

The practice used its website to inform patients how to make the best use of the health services available. For example, patients could book appointments online. Patients were able to request their prescriptions electronically and have them sent to the pharmacist of their choice via an automated system.

The practice had regular liaison with an independent pharmacy attached to the practice which was open seven days a week until 10pm. This enabled patients in this population group to collect their prescriptions at a time convenient to them.

Late appointments were available on Tuesdays, Wednesdays and Fridays until 7.15pm. This enabled working people to make appointments at a time convenient to them.

People whose circumstances may make them vulnerable

Good

Updated 8 May 2015

The practice is rated as good for people whose circumstances may make them vulnerable.

The practice considered that vulnerable patients could be of any age. For example, patients may be classed as vulnerable due to homelessness, learning disability, social circumstances, elderly and frail or unable to speak English.

The practice held weekly GP meetings in which they discussed any vulnerable patients that there were concerns about. This included safeguarding concerns. These meetings were minuted and recorded in writing.

The practice monitored all of its patients with learning disabilities. These patients were invited annually in for a yearly health check. The practice had also devised an easy to read practice information leaflet and other easy read materials which helped to ensure that patients understood how to access the services available. The practice also had scale models of body parts which were used to explain care and treatment to patients.

The practice had a plan in place to obtain easy to read versions of all health information leaflets in its waiting room.

Staff told us that they understood how to arrange language interpretation for any patients who were unable to communicate in English.

The practice had a portable hearing induction loop for patients who used a hearing aid.

The practice held regular palliative care meetings to discuss end of life care. All recent patient deaths were reviewed at these meetings regardless of circumstances in case there was any learning to be shared.

People experiencing poor mental health (including people with dementia)

Good

Updated 8 May 2015

The practice is rated as good for providing care to people experiencing poor mental health.

The practice maintained registers which showed that they currently had 66 patients who suffered from dementia. There were 48 patients on the practice mental health register. Practice staff kept these registers up to date.

All patients in this population group were invited to have an annual review, including a review of their physical health. The practice invited the local community psychiatric nurse and dementia liaison nurse to its regular multi-disciplinary team meetings so that they could discuss any concerns with the wider team as appropriate. This facilitated a joined up approach to fully support patients in this population group.

The practice liaised with two mental health support groups and provided facilities for them to run clinics from the practice on a regular basis. In addition the practice worked closely with a local consultant psychiatrist. The mental health single point of access team also worked closely with the practice and saw patients on the premises.

The practice supported patients experiencing alcohol and substance misuse by helping support groups to hold clinics at the practice. The practice had acted on feedback which demonstrated having these organisations hold their clinics at the practice made access much easier for patients.