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Inspection Summary


Overall summary & rating

Good

Updated 24 November 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queensway Medical Centre on 1 September 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.
  • The practice participated in local audits, national benchmarking, GP revalidation audits, peer review and research. However we found that the findings of these audits were not held centrally to gain an overview.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they could make an appointment with a GP and there was continuity of care, with urgent appointments available the same day.
  • Lower patient satisfaction levels were reported with the reception as well as telephone access to the practice.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Develop a coordinated approach to clinical audit.

  • Continue to seek and support patients who are also carers.

  • Continue with the plans to monitor and ensure improvement to patient experience, including access to appointments and reception staff.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 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.

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients received support, information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had defined systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 24 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable to the national average.

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

  • The practice participated in local audits, national benchmarking, GP revalidation audits, peer review and research. However we found that the findings of these audits were not held centrally to gain an overview.

  • 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.

  • The practice is situated in an area which is ranked highly on the deprivation indices. The practice was aware of the need to engage with the population in specific health promotion activities related to lifestyle including smoking and the associated respiratory issues, alcohol and substance addiction.

Caring

Good

Updated 24 November 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice below than others for some aspects of care for example the practice opening times and getting through to the practice by telephone.

  • 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 24 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 Nene Clinical Commissioning Group to secure improvements to services where these were identified. For example the practice was working collaboratively with other local practices to establish a paediatric urgent care centre.

  • Patients said they could get an appointment with a GP and 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 24 November 2016

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

  • The practice had a clear vision to provide high quality healthcare for the local population through a range of modern services, delivered by a highly skilled professional team including doctors, nurse practitioners, treatment room nurses, health care assistants, midwives, managers and administrative staff.

  • There was a 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 a governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • 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 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

People with long term conditions

Good

Updated 24 November 2016

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

  • Clinical staff trained in chronic disease management including a specialist diabetic nurse had lead roles in supporting patients with long term conditions such as diabetes, asthma and chronic obstructive pulmonary disease (COPD).
  • Performance for diabetes related indicators were comparable the national average. For example, the percentage of patients with diabetes, on the register, in whom the last blood glucose reading showed good control in the in the preceding 12 months (01/04/2014 to 31/03/2015), was 74%, compared to the CCG average of 79% and the national average of 78%.
  • 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 or at high risk of hospital admission, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care including opportunistic reviews of their care.
  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 24 November 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 CCG and national averages for all standard childhood immunisations.

  • 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.

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

  • The practice provided contraceptive advice and services.

  • The practice provided a variety of health promotion information leaflets and resources for this population group.

  • The practice provided a minor injury clinic allowing families and young children local access to this service without the need to attend a hospital.

  • The practice provided an interpreter service for young families of Eastern European origin.

Older people

Good

Updated 24 November 2016

The practice is rated as good for the care of older people.

  • Patients aged 75 years and older had a named GP.

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

  • The GPs supported by the care coordinator routinely worked with the community nursing services to ensure continuity of care for patients who needed care at home.

  • Through the Pro-active Care (PAC) meetings the practice regularly reviewed patients with palliative care needs, those that needed end of life care and older vulnerable patients with the community and the palliative care nurses.

  • The practice had identified older patients at high risk of admissions to hospital (patients with multiple complex needs, and involving multiple agencies) and worked with local partners to coordinate their care.

  • The GPs routinely visited two local care homes once each week for a ward round to ensure continuity of care for patients.

  • The practice offered influenza vaccinations for older and at risk patients.

Working age people (including those recently retired and students)

Good

Updated 24 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, flexible and offered continuity of care.

  • The practice offered extended hours, predominantly for working patients, every Tuesday evening until 8pm and every other Saturday from 8.30am till 11.15am.

  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.

  • The practice offered health checks, travel advice, cervical screening, and contraceptive services for this population group.

People experiencing poor mental health (including people with dementia)

Good

Updated 24 November 2016

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

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

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

  • 81% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average.

  • The practice maintained a register of patients with mental illness and offered them annual health reviews.

  • The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations including direct access to counselling and cognitive behavioural therapy.

  • Counselling services were available at the practice for patients with mental health issues which was provided by a Wellbeing Counsellor and available during Tuesday extended hours.

  • The practice had a system in place to follow up patients who had attended A&E 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.

People whose circumstances may make them vulnerable

Good

Updated 24 November 2016

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

  • 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.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

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

  • Through the Pro-active Care (PAC) meetings the practice regularly reviewed patients with palliative care needs, those that needed end of life care and older vulnerable patients with the community and the palliative care nurses.

  • The Advanced Nurse Practitioner offered home visits, particularly to elderly vulnerable patients to carry necessary reviews, influenza vaccinations and acute dressings.

  • The practice identified patients who were also carers and signposted them to appropriate support. The practice had identified 165 patients as carers (1% of the total practice list).