You are here

Inspection Summary


Overall summary & rating

Good

Updated 16 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Flowers Health Centre on 23 March 2016. Although, the overall rating for the practice was good, we found the safe domain required improvements. The full comprehensive report on the 23 March 2016 inspection can be found by selecting the ‘all reports’ link for The Flowers Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 February 2017. To confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 23 March 2016. This report covers our findings in relation to those requirements and any additional improvements made since our last inspection.

.Overall, the practice is now rated as good in the safe domain and good overall.

Our key findings were as follows:

  • At our previous inspection on 23 March 2016, we rated the practice as requires improvement for providing safe services, we found that staff had not had the necessary recruitment checks prior to staff commencing work. These arrangements had significantly improved when we undertook a follow up inspection on 8 February 2017. We reviewed three personnel files and found the practice had undertaken the appropriate recruitment checks prior to staff commencing work.

  • At our previous inspection on 23 March 2016, we found that the practice did not maintain a record of actions taken in response to National Patient Safety Alerts (NPSA). in regards to equipment and medication. At this inspection, we found the practice manager maintained a record of each NPSA and what actions the staff had taken.

  • At our previous inspection on 23 March 2016, we found staff could not locate the procedures to follow if a needle stick injury occurred and copies of the procedure were not located in areas where this injury may occur. At this inspection, we found staff had reviewed and could locate the policy and posters about the actions to take if an injury occurred were located in the treatment rooms.

  • At our previous inspection on 23 March 2016, we found that staff had not always cleaned equipment used for patient care in line with the manufacturer’s instructions and had not maintained records to monitor the cleaning. At this inspection, we found staff had information about how to clean the equipment following the manufacturer’s guidance and staff had kept a record of when it was cleaned.

  • At our previous inspection on 23 March 2016, we found the practice had a defibrillator available on the premises and oxygen with adult and children’s masks, but we noted that the equipment was only checked to ensure it was in working order once a month. At this inspection, we found staff checked the equipment daily.

  • At our previous inspection on 23 March 2016, patients told us that they had difficulty in contacting the practice by telephone. At this inspection, we found the practice had identified issues with the telephone lines, which had been addressed. Prior to this inspection, they had carried out a questionnaire that asked patients ‘do you have a problem getting through on the phone today’. The practice had 17 responses, 12 were completely satisfied, and five stated they got through on the second call.

  • At our previous inspection on 23 March 2016, we found that the practice manager could not demonstrate how they ensured that the practice nurses had completed the necessary role specific training and updates. At this inspection, we found the practice manager kept an overview of all role specific training for staff and had ensured the nurses had completed their role specific training. However, we found that the record showed that staff had not completed adult safeguarding training. Following the inspection the practice manager provided us with information to demonstrate staff had completed training

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 March 2017

  • The practice had carried out the necessary recruitment checks.
  • The practice manager maintained a record of each National Patient Safety Alert and what actions the staff had taken.

  • Staff had reviewed and could locate the needle stick policy. Posters about the actions staff needed to take if a needle stick injury occurred were located in the treatment rooms.

  • Staff had information about how to clean clinical equipment following the manufacturer’s guidance and had recorded when they cleaned the equipment.

  • Staff checked the defibrillator and oxygen equipment daily.

Effective

Good

Updated 17 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment although some role specific training was not up to date..

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

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 17 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice mostly in line with others for several aspects of care.

  • 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.

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

Responsive

Good

Updated 17 May 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 had good facilities and was well equipped to treat patients and meet their needs.

  • Patients could access same day appointments.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 17 May 2016

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 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.

  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk. However, areas such as recruitment, monitoring staff training requirements and care of equipment required improvement.

  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

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

Checks on specific services

Older people

Good

Updated 17 May 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.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice worked closely with the local care home undertaking weekly visits and regular reviews of medicines. They also visited a local extra care complex weekly.

People with long term conditions

Good

Updated 17 May 2016

The practice is rated as good for the care of people with long-term conditions.

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

  • Performance for diabetes related indicators was 94%, which was similar to the CCG average of 90% and national average of 89%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and 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

Good

Updated 17 May 2016

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

  • 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.

  • Immunisation rates were comparable to local averages for all standard childhood immunisations. Systems were in place to follow up patients who did not attend and practice nurses visited patients at home where they had not attended for immunisations.

  • Performance for asthma care was 80%, significantly below the CCG average of 98% and the national average of 97%. The practice was aware of these figures and had put systems in place to improve care for patients. We were shown performance figures for 2015/16 which indicated an improvement in all areas related to asthma. For example, one of the indicators showed the percentage of patients with asthma, on the register, who had received an asthma review in the preceding 12 months, had risen from 59% in 2014/15 to 74% in 2015/16.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • The practice’s uptake for the cervical screening programme was 92%, which was comparable to the CCG average of 89% and the national average of 82%.

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

  • We saw positive examples of joint working with midwives and health visitors.

Working age people (including those recently retired and students)

Good

Updated 17 May 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, 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 17 May 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 homeless people and those with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • 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 normal working hours and out of hours.

  • We saw one area of out standing pratice. The practice had initiated a project to improve the care for patients with advance care plans. They had identified a number of incidents where agreed care plans had not been adhered to for patients in care home settings and 999 ambulances had been called resulting inpatient admissions to hospital. The aim of the project was to reduce unnecessary emergency department attendances and hospital admissions for patients and ensure patients wishes were respected.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 May 2016

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

  • 86% of patients diagnosed with dementia who had had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.

  • Performance for mental health related indicators was 90% which was similar to the CCG average of 94% and national average of 93%.

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

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

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

  • The practice 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 patients with mental health needs and dementia.