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Greenmoss Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 2 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Greenmoss Medical Centre on 10, 17 and 24 January 2017.

Overall the practice is rated as good.

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

  • There were systems in place to reduce risks to patient safety, for example, equipment checks were carried out, staff were trained to manage medical emergencies and procedures were in place to promote infection control.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff were aware of procedures for safeguarding patients from the risk of abuse.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.

  • Staff felt well supported. They had access to training and development opportunities and had received training appropriate to their roles.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw staff treated patients with kindness and respect.

  • Services were planned and delivered to take into account the needs of different patient groups.

  • Access to the service was monitored to ensure it met the needs of patients.

  • Information about how to complain was available. There was a system in place to manage complaints.

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

We saw an area of outstanding practice:

  • A member of the Patient Participation Group (PPG) had set up a Patient and Carers Group that had been established for six years and was now run every Friday from a room at the Greenmoss Medical Centre. Patients were able to drop-in for a cup of tea and advice and support around health and social issues. For example, the group had assisted patients to make healthcare appointments, attend hospital visits and access social services. The Patient and Carers Group also provided support to socially isolated patients. The group had close links with the Police Community Support Officer who visited the group to provide information on local matters which were of concern to patients. The group had established a patient transport service due to the limited availability of public transport and the rural nature of the local community. This was funded by donations and subscriptions and provided transport to the Patient and Carers Group, GP and hospital appointments.

The areas where the provider should make improvements are:

  • Review the process for regular monitoring of prescriptions that have not been collected.

  • Implement a system for tracking blank prescription forms through the practice in accordance with national guidance.

  • Maintain a central record of training undertaken by all staff to assist with monitoring their training needs.

  • Arrangements should be introduced to ensure the outcome from audits are regularly shared between clinicians.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 2 March 2017

The practice is rated as good for providing safe services. Safety events were reported, investigated and action taken to reduce the chance of a re-occurrence. There were appropriate systems in place to ensure that equipment was safe to use. There were systems to protect patients from the risks associated with insufficient staffing levels, medicines management and infection control. Staff were aware of procedures for safeguarding patients from the risk of abuse. We found that improvements should be made to the management of medication.

Effective

Good

Updated 2 March 2017

The practice is rated as good for providing effective services. Patients’ needs were assessed and care was planned and delivered in line with current legislation. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Staff worked with other health care teams and there were systems in place to ensure appropriate information was shared. Quality monitoring took place however we found arrangements should be introduced to ensure the outcome from audits are regularly shared between clinicians. Staff had

access to training and development opportunities and had received training appropriate to their roles

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A c

entral record of training undertaken by all staff should be maintained to assist with monitoring their training needs.

Caring

Good

Updated 2 March 2017

The practice is rated as good for providing caring services. We saw that staff treated patients with kindness and respect. Patients spoken with and who returned comment cards were positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful. Patients felt involved in planning and making decisions about their care and treatment.

Responsive

Good

Updated 2 March 2017

The practice is rated as good for providing responsive services. Services were planned and delivered to take into account the needs of different patient groups. A range of access to the service was provided and this was monitored to ensure it met the needs of patients.

The practice had a complaints policy which provided staff with clear guidance about how to handle a complaint.

Well-led

Good

Updated 2 March 2017

The practice had a vision and strategy to deliver high quality care and promote good outcomes for patients. 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 and staff meetings. The practice proactively sought feedback from staff and patients, which it acted on.

Checks on specific services

People with long term conditions

Good

Updated 2 March 2017

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The practice aimed to ensure that patients were able to have their long term conditions reviewed in one visit to reduce the need for multiple appointments. For example, if a patient needed to see the dietician a same day appointment would be made. The nursing team took the lead for different long term conditions and kept up to date in their specialist areas. A practice nurse made home visits to carry out reviews. They worked closely with the community matron and complex care practitioner to support patients with long term conditions who were housebound which assisted in preventing hospital admissions. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access to specialist help when needed. In-house ECG examinations, 24 hour ambulatory blood pressure monitoring and spirometry services were also provided.

Families, children and young people

Good

Updated 2 March 2017

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Childhood immunisation rates for the vaccinations given were comparable to local and in some instances above national averages. Priority was given to young children who needed to see the GP and appointments were available outside of school hours. The appointment system also provided flexibility, for example, appointments could be booked up to eight weeks in advance which assisted families to plan an appointment time that best suited their needs. The GPs liaised with other health care professionals, such as health visitors to ensure the needs of vulnerable children were addressed. Meetings with the health visiting services were held every two months allowing any concerns to be discussed. Accident and emergency attendances were monitored. Family planning services were also provided.

Older people

Good

Updated 2 March 2017

The practice is rated as good for the care of older people. The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles. Home visits were carried out by GPs and practice nurses to housebound patients to carry out reviews of health, respond to health concerns and administer flu vaccinations. The practice worked with other agencies and health providers to provide support and access specialist help when needed. Multi-disciplinary meetings were held to discuss and plan for the care of frail and elderly patients. The practice met with community matrons and the complex care practitioner to coordinate medical and social care for older patients or patients with complex needs. This specialist help supported patients who may otherwise require a hospital admission. Older patients were able to access the Patient and Carers Group that ran every Friday from a room at the Greenmoss Medical Centre. Patients were able to drop-in for a cup of tea and advice and support around health and social issues. The group had close links with the Police Community Support Officer who visited the group to provide information on local matters which were of concern to patients. The group had established a patient transport service due to the limited availability of public transport and the rural nature of the local community. This was funded by donations and subscriptions and provided transport to the Patient and Carers Group, GP and hospital appointments.

Working age people (including those recently retired and students)

Good

Updated 2 March 2017

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice appointment system and opening times provided flexibility to working patients and those in full time education. Patients could access services at either the Rode Heath Surgery or Greenmoss Medical Centre between the hours of 8am to 6.30pm Monday to Friday. The appointment system provided pre-bookable and on the day appointments. GP appointments could be booked up to eight weeks in advance. Patients could book appointments in person, via the telephone and on-line. Repeat prescriptions could be ordered on-line or by attending the practice. Telephone consultations were also offered. The practice website provided information around self-care and local services available for patients. The practice offered health promotion and screening that reflected the needs of this population group such as cervical screening, NHS health checks, smoking cessation advice and family planning services. Reception staff sign-posted patients who did not necessarily need to see a GP. For example to services such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP). The practice hosted health services such as phlebotomy, community dietician, community mental health worker, antenatal care and an orthopaedic clinic which meant patients could receive these services locally rather than having to travel to another service. A physiotherapy service is going to be based at the service from February 2017.

People experiencing poor mental health (including people with dementia)

Good

Updated 2 March 2017

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. Longer appointments were also offered. The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice referred patients to appropriate services such as psychiatry and counselling services. A community mental health worker was based at the practice and ran a weekly clinic which meant patients were able to access support locally. The staff team had received training in dementia awareness to assist them in identifying patients who may need extra support.

People whose circumstances may make them vulnerable

Good

Updated 2 March 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example,

if a patient had a learning disability to enable appropriate support to be provided.

The practice worked with health and social care services to support the needs of vulnerable patients.

Se

rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. A member of staff was the carer’s link. The practice referred patients to local health and social care services for support, such as drug and alcohol services. Staff had received safeguarding training relevant to their role and they understood their responsibilities in this area. Monthly multi-disciplinary meetings were held which were an effective way of identifying vulnerable patients and any support they required.

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