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Archived: E7 Health Good

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Inspection Summary


Overall summary & rating

Good

Updated 6 June 2017

Letter from the Chief Inspector of General Practice

The practice is rated good overall and good for providing safe services.

We carried out an announced comprehensive inspection of this practice on 26 January 2016. The overall rating for the practice was good. However, a breach of legal requirements was found during that inspection within the safe domain. After the comprehensive inspection, the practice sent us evidence and actions detailing what they would do to meet the legal requirements. We conducted a focused inspection on 4 May 2017 to check that the provider had followed their plans and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements.

During our previous inspection on 22 January 2016 we found the following area where the practice must improve:

  • Ensur

    recruitment 

    arrangements 

    include 

    all 

    necessar

    y pre-employment 

    checks 

    for 

    all 

    staff.

Our previous report also highlighted the following areas where the practice should improve:

  • Carry out further clinical audits and re-audits to improve the quality of patient outcomes.
  • Implement a system to monitor use of prescription pads. 

  • Ensure Patient Group Directives (PGDs) and Patient Specific Directives (PSDs) are consistently authorised.
  • Ensure all staff receive annual (BLS) training in Basic Life Support.
  • Ensure Legionella water testing is carried out regularly and regular fire drills are undertaken. 

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link on our website at www.cqc.org.uk

During the inspection on 4 May 2017 we found:

  • Arrangements were in place

    include 

    all necessary 

    pre-employment 

    checks 

    for 

    all 

    staff.

  • The practice had undertaken several completed audits that improved patient outcomes.

  • Effective systems were in place to monitor the use of prescription pads.

  • All staff had received annual Basic Life Support (BLS) training.

  • Staff had conducted 

    regular fire drills and Legionella water testing had been undertaken.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 June 2017

The practice is now rated good for delivering safe services.

At our last inspection on 26 January 2016 we found that most safety systems and processes and monitoring risks to patients were well managed. However, there were gaps in arrangements for Legionella water testing and fire drills, staff basic life support training and recruitment checks, and monitoring the use of prescriptions, Patient Group Directions (PGDs) to allow nurses to administer medicines in line with legislation and Patient Specific Directions (PSDs) to enable Health Care Assistants to administer vaccinations after specific training when a doctor or nurse were on the premises.

At this inspection, we found that the practice had implemented actions to ensure that all these issues had been fully addressed. Effective arrangements for PGDs, PSDs and tracking of blank prescriptions were in place. Systems to ensure regular Legionella water testing were in place and water was certified safe. Fire drills were carried out regularly and learning points were noted and actioned by staff. Staff had received BLS training and the practice changed its systems for recruitment checks to ensure all were undertaken before employment. 

Effective

Good

Updated 6 June 2017

Caring

Good

Updated 6 June 2017

Responsive

Good

Updated 6 June 2017

Well-led

Good

Updated 6 June 2017

Checks on specific services

People with long term conditions

Requires improvement

Updated 6 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.
  • The practice had identified 7% of its patients had diabetes. Performance for diabetes related indicators was 71% overall , which was below the CCG average of 87% and the national average of 89%.The latest data showed that 86% of patients with diabetes on the register had recently been seen for a foot assessment, which was comparable to the national average of 88%.
  • Records we reviewed showed that full annual reviews were carried out for patients with Chronic Obstructive Pulmonary Disease (COPD), asthma and diabetes.
  • Longer appointments and home visits were available when needed.
  • 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 6 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 were on the child protection register.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • Sixty-nine per cent of patients diagnosed with asthma, on the register had an asthma review in the last 12 months which was comparable to 75% nationally.
  • 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.
  • Eighty per cent of women aged 25-64 had a cervical screening test within the last five years which was comparable to 82% nationally.
  • Appointments were available outside of school hours through the extended hours hub of local practices and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.
  • The practice provided oral and injectable contraceptive services in-house. For other contraceptive services patients were signposted to local family planning clinics.

Older people

Good

Updated 6 May 2016

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

  • It offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice had identified 92 older patients at risk of avoidable unplanned admission to hospital that had an agreed care plan, which was 2.5% of patients on the register.
  • The practice had a policy to contact all older patients at risk following either an A&E attendance or emergency admission to hospital.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 6 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.
  • The provider had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • The practice was very proactive in offering online services including via an app, as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 May 2016

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

  • 89% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%
  • 100% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in which was comparable to the national average of 88%
  • 95% of patients with schizophrenia, bipolar affective disorder and other psychoses alcohol consumption had been recorded which is comparable to the national average of 90%
  • 95% of patients with physical and/or mental health conditions had a recorded smoking status in the preceding 12 months which was comparable to the national average of 94%
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients 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.

People whose circumstances may make them vulnerable

Good

Updated 6 May 2016

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

  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • Non-registered vulnerable patients were seen immediately as necessary.
  • Staff signposted vulnerable people to local support groups, voluntary organisations and locally available services such as a CCG commissioned transitional practice for homeless people and travellers, ten minutes’ walk from the surgery.
  • 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.