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We are carrying out checks at Church View Medical Centre using our new way of inspecting services. We will publish a report when our check is complete.

Inspection Summary


Overall summary & rating

Good

Updated 19 March 2015

Letter from the Chief Inspector of General Practice

Church View Medical Centre was inspected on Wednesday 26 November 2014. This was a comprehensive inspection.

There were two GP partners at this practice (one female and one male), with a team of staff in place to provide a service to approximately 2,200 patients in the village of Broadway and the surrounding areas of Horton, Ilminster and Hatch Beauchamp. The practice also had a dispensary. A dispensing practice is where GPs are able to prescribe and dispense medicines directly to patients who live in a rural setting which is a set distance from a pharmacy.

Patients using the practice also have access to community staff including district nurses, community psychiatric nurses, health visitors, physiotherapists, speech therapists, counsellors, podiatrists and midwives.

We rated this practice as good.

Our key findings were as follows:

The practice was well led and responded to patient need and feedback. There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on. The practice had a patient participation group, who ensured patient feedback was relayed to the practice and that comments were acted upon.

Patients liked having a named GP, which they told us improved their continuity of care. The practice was clean, well-organised, was purpose built with good facilities and was well equipped to treat patients. There were effective infection control procedures in place.

Feedback from patients about their care and treatment was consistently positive. We observed a non-discriminatory, person centred culture. Staff told us they felt motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. Views of external stakeholders were very positive and aligned with our findings.

Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessment of mental capacity and safeguarding concerns to make decisions about care and treatment, and the promotion of good health.

Suitable recruitment, pre-employment checks, induction and appraisal processes were in place and had been carried out thoroughly. There was a culture of further education to benefit patient care and increase the scope of practice for staff.

Documentation received about the practice prior to and during the inspection demonstrated the practice performed comparatively with all other practices within the clinical commissioning group (CCG) area.

Patients felt safe in the hands of the staff and felt confident in clinical decisions made. There were effective safeguarding procedures in place.

Significant events, complaints and incidents were investigated and discussed. Actions were taken in response to such events showing that learning and improvements had taken place.

In relation to areas for improvement, the provider should:

  • Training in the workings of the Mental Capacity Act (2005) should be extended to all practice nursing staff.
  • The practice would benefit from formalised clinical meetings to ensure learning is evaluated.
  • The provider should ensure that procedures in place for handling controlled drugs are always followed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 March 2015

The practice is rated as good for providing safe services.

Patients we spoke with told us they felt safe, confident in the care they received and well cared for.

Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Significant events and incidents were investigated systematically and formally. Reporting of learning for the staff team as a result of significant events was not always clear because events were not consistently discussed with the whole staff team.

Risks to patients were assessed and well managed. There were enough staff to keep people safe and to provide an unhurried service with time to listen to patients’ needs. Staffing levels and skill mix were planned and reviewed so that patients received safe care and treatment at all times. There were no staff vacancies.

Recruitment procedures and checks were completed as required to help ensure that staff were suitable and competent. Risk assessments were performed when a decision had been made not to perform a criminal records check on administration staff.

Staff were aware of their responsibilities in regard to safeguarding. GPs had received training in the Mental Capacity Act (2005) and had good awareness of how to apply the act during their clinical practice. There were safeguarding policies and procedures in place that helped identify and protect children and adults who used the practice from the risk of abuse.

There were arrangements for the efficient management of medicines within the practice.

The practice was clean, tidy and hygienic. Arrangements were in place that helped ensure the cleanliness of the practice was consistently maintained. There were systems in place for the retention and disposal of clinical waste.

Effective

Good

Updated 19 March 2015

The practice is rated as good for providing effective services.

Data showed patient outcomes were at or above average for the locality.

Systems were in place to help ensure that all GPs and nursing staff were up-to-date with both national institute for health and care excellence (NICE) guidelines and other locally agreed guidelines. Evidence confirmed that these guidelines were influencing and improving practice and outcomes for patients. For example, the practice held monthly Gold Standard Framework meetings with members of community health professionals to plan palliative and end of life care for patients with life limiting illnesses, which put the patients’ views at the centre of their care planning.

People’s needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health.

Staff had received training appropriate to their roles and any further training needs have been identified and planned. The practice could identify all appraisals and the personal development plans for all staff. There was a systematic induction and training programme in place with a culture of further education to benefit patient care and increase the scope of practice for staff. Effective multidisciplinary working was evidenced.

Regular completed audits were performed of patient outcomes which showed a consistent level of care and effective outcomes for patients. We saw evidence that audit and performance was driving improvement for patient outcomes. For example, by completing assessments of patients at risk of fracture from osteoporosis in order to offer additional screening services and treatment.

Caring

Good

Updated 19 March 2015

The practice is rated as good for providing caring services.

Feedback from patients about their care and treatment was consistently and strongly positive. We observed a patient-centred culture. The practice had a patient participation group (PPG) that ensured patients’ views reached the practice and that comments and suggestions were heard and acted upon.

Staff were motivated and inspired to offer kind and compassionate care. We found many positive examples to demonstrate how people’s choices and preferences were valued and acted on. We received comments about the practice from 24 patients; all comments about the caring attitude of staff were positive and complimentary.

Views of external stakeholders were very positive and aligned with our findings.

Information was provided to help patients understand the care available to them. Leaflets for a range of medical conditions and contacts for support services were displayed in the waiting areas. People with long standing health conditions or vulnerable patients had individual care plans to help support and manage their needs.

Responsive

Good

Updated 19 March 2015

The practice is rated as good for providing responsive services.

Patients told us that there was continuity of care, with 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 that the practice responded quickly to issues raised. There was evidence of complaints being responded to in a timely way and resolved to the satisfaction of the person who had complained.

The practice had developed links with village advocacy services for vulnerable or housebound patients. Regular consultation between the practice and village groups ensured vulnerable patients had access to GP services when they needed it.

Well-led

Good

Updated 19 March 2015

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

It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management.

The practice had a number of policies and procedures to govern activity and held regular governance meetings to share learning from any events.

There were systems in place to monitor and improve quality and identify risk.

Staff had received inductions, regular performance reviews and attended staff meetings and events.

Checks on specific services

Older people

Good

Updated 19 March 2015

Patients aged 75 and over had their own allocated GP but could also see an alternative GP if they preferred. Pneumococcal, shingles and flu vaccines were provided at the practice. The GPs ensured they visited housebound patients on their caseload and practice nurses visited housebound patients in their homes to administer vaccinations. The practice had a dispensary. This ensured patients could obtain their prescribed medications at the practice as it was situated in a rural setting which was a set distance from a pharmacy. Pharmacy staff also on occasion delivered prescribed medicines to housebound patients who needed medicines urgently. The GPs visited older patients who required a visit following discharge from hospital or arranged for the community matron to do this on their behalf if appropriate.

Clinics specifically for older people were not held at the practice, but treatment was organised around the individual patient and any specific medical condition they had.

The practice had a system to identify older patients and was appropriately involved in the local complex care team (CCT). Vulnerable patients were discussed at meetings held on alternate weeks to identify and review any patients at risk. The work undertaken by the GP team had contributed to the practice’s participation in the national initiative to avoid unplanned admission to hospitals by providing an enhanced service.

The practice website included a number of links containing extensive information about the promotion of health for medical conditions which affect older people.

Consulting rooms were located on the ground floor, with level access, avoiding the need to climb stairs. In waiting areas there were chairs of varying heights, some with arms, for ease of use for older patients with mobility problems.

People with long term conditions

Good

Updated 19 March 2015

The practice identified patients who might be vulnerable, including those with multiple or specific complex or long term needs and ensured they were offered consultations or reviews where needed. The staff at the practice maintained links with external health care professionals for advice and guidance.

Patients with long term conditions had a nominated GP and tailor-made care plans in place. Patients were pleased with the care they received for their long term conditions and were offered specific clinics for monitoring and treatment of conditions. These included warfarin monitoring, asthma, diabetes, family planning and ante-natal care. Health promotion for patients at the practice included those with long term conditions.

The diabetic clinics supported and treated patients with diabetes which included education for patients to learn how to manage their diabetes through the use of insulin. Health education about healthy diet and life style was provided. Patients were issued with insulin information cards which could be used for reference if the patient was on holiday or away from the practice. Diabetic patients had a twice yearly health check.

Home visits and medication reviews were provided for patients with long term conditions who had been recently discharged from hospital.

Patients receiving certain medicines were able to access screening services at the practice to make sure the medication they received was effective. This included, for example, patients on warfarin medicine (a blood thinning medicine) early or mid-week appointments to check blood levels. This was so that results were back before the weekend allowing any adjustments to medicines to be made before the weekend closure of the practice.

The practice used a specific computerised patient record system allowing out of hours service providers to access information on specific patients with the aim of treatment being seamless for the patient. GPs and out of hours doctors were thus aware of any treatment that had been given to people with long term conditions or those at the end of their life.

Families, children and young people

Good

Updated 19 March 2015

There were baby and child immunisation programmes available to ensure babies and children could access a full range of vaccinations and health screening.

Ante-natal care was provided by a midwife who held clinics at the practice. The midwife had access to the practice computer system and could speak with a GP should the need arise. The practice also had relationships with health visitors and the school nursing team, and was able to access support from children’s workers and parenting support groups.

Parents were invited to bring their children to regular developmental check-ups with their GP. The practice referred patients to a local family and child service to discuss any vulnerable babies, children or families.

Men, women and young people had access to a full range of contraception services. Men, women and young people had access to sexual health screening including chlamydia testing and cervical screening for women.

There were not specific clinics or services for younger people but staff were aware of steps to take to report safeguarding concerns about children and young people. All staff had attended safeguarding training appropriate to their roles.

Working age people (including those recently retired and students)

Good

Updated 19 March 2015

Health checks were available to patients aged between 40 and 74.

The practice offered one evening surgery until 7pm, outside of normal opening times to help patients of working age attend appointments. Patients could request appointments in person or by phone. Telephone consultations were also available.

Travel advice was available from the GPs and nursing staff within the practice and supporting information leaflets were available. Pneumococcal vaccination and shingles vaccinations were provided for patients at risk.

The staff carried out opportunistic health checks on patients as they attended the practice. This included offering referrals for smoking cessation, providing health information, routine health checks and reminders to have medicine reviews. The practice also offered age appropriate screening tests including for prostate cancer and cholesterol testing.

People whose circumstances may make them vulnerable

Good

Updated 19 March 2015

The practice had a very low number of registered patients with a learning disability. They were offered an annual health check, during which their long term care plans were discussed with them and their carer if appropriate.

Patients for whom English was not their first language were offered interpretation and translation services. The practice had low numbers of registered patients speaking English as a second language.

Patients with alcohol and drug addictions were referred to the local treatment service.

GPs had often referred vulnerable, housebound patients to the community nurses who visited them at home to assess their needs. Staff from the practice also visited patients at home when they have expressed reluctance to attend the practice for either emotional or health reasons. The practice had patients registered at two local nursing homes, where GPs made regular calls to review these patients’ health needs.

The practice worked with community health care professionals including physiotherapists and mental health workers to make sure vulnerable patients were visited in their homes to assess needs and facilitate provision of any equipment, mobility or medication.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 March 2015

The practice had a register of patients with mental illness, depression and dementia. All were offered regular checks, opportunistically and by invitation. For example, homeless patients with mental health needs were able to see a GP on the day if they came to the practice reception.

GPs, nursing and administrative staff had attended dementia and learning disability awareness sessions.

Mental health medicine reviews were conducted to ensure that patients’ medicines remained appropriate and that the dose was still correct. Blood tests were regularly performed on patients receiving certain mental health medications to provide the GP with the information they needed to adjust the dosage.