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Rood End Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 21 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Rood End Medical Centre on 4 May 2017. 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 a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Feedback from patients through the National Patient Survey (published July 2016) was mixed about access. Patients were happy with their experience but sometimes had difficulties in obtaining an appointment. The practice had been proactive in taking action. The number of patients had increased over the last year and appointments were monitored on an on-going basis. We received positive comments on access through our CQC comment cards.
  • 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 the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • The practice was well organised.

The areas where the provider should make improvement are:

  • Review systems for monitoring the cleaning of clinical equipment and storage areas for cleaning equipment.
  • Ensure systems for routine checking and recording of relevant staff registration with their professional bodies are maintained ensure the information is kept up to date.
  • Review systems for uncollected prescriptions.
  • Review impact of changes to access on patient satisfaction and take further action as appropriate.
  • Consider how uptake of national cancer screening programmes for breast and bowel cancer and uptake childhood vaccinations for 5 year olds could be improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 June 2017

The practice is rated as good for providing safe services.

  • From the sample of documented examples we reviewed, we found there was an effective system 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 were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety.
  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.
  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 21 June 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed in most areas patient outcomes were at or above average compared to the national average.
  • Staff were aware of current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills and knowledge to deliver effective care and treatment.
  • There was evidence of appraisals and staff were supported in their personal development.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • The practice supported patients to lead healthier lifestyles. However, uptake of national screening programmes for breast and bowel cancer was below CCG and national averages.

Caring

Good

Updated 21 June 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with others in the CCG area and nationally for most aspects of care.
  • Survey information we reviewed showed that 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 accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 21 June 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. For example, the practice was participating in the CCG led primary care commissioning framework aimed at improving services and patient outcomes locally.
  • The practice provided accessible services and in-house services for the convenience of patients.
  • The latest published National Patient Survey (published in July 2016) showed patients were happy with their experience of making an appointment and getting through on the telephone but gave mixed feedback about actually obtaining an appointment. The practice had taken action in response to this feedback such as increasing numbers of appointments and on-going monitoring. We received positive comments through the CQC comment cards on access to appointments.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and evidence from examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 21 June 2017

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 their roles and responsibilities.
  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.
  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.
  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.
Checks on specific services

People with long term conditions

Good

Updated 21 June 2017

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

  • Clinical staff took lead roles in the management of long term conditions.
  • Nationally reported outcome data showed the practice performed well across most long term conditions. For example, outcome data for patients with diabetes was above the CCG and national average overall (100% compared with the CCG average of 88% and national average of 90%). The practice also had lower exception reporting for diabetes indicators at 9% compared to the CCG average of 11% and national average of 12%).
  • The practice had undertaken a clinical audit to improve the referral of patients with diabetes to structured education programmes.
  • Regular reviews of the practice list were undertaken to improve the accuracy of the long term conditions registers.
  • Various services were provided at the practice for the convenience of patients for example clinics with a diabetes consultant and specialist diabetes nurse.
  • For the convenience of patients some diagnostic and monitoring services were available from the practice which included electrocardiographs (ECGs) and spirometry. The practice also loaned out blood pressure monitors to patients.
  • Patients with long-term conditions received annual reviews of their health and medication. Those with the most complex needs were discussed in a multi-disciplinary team setting with relevant health care professionals.

Families, children and young people

Good

Updated 21 June 2017

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

  • The practice had a younger population compare to the local CCG area and nationally. For example, the practice had a higher than average number of patients aged 0 to 4 years, 9.6% compared to the CCG average of 6.9% and national average of 5.8%.
  • Nationally reported immunisation rates for 2015/16 showed the practice was achieving above the 90% national standard for the under two year olds standard childhood immunisations and was slightly lower than CCG and national average for MMR vaccines for 5 year olds. The latest data from the practice for 2016/17 (un-validated) showed standards for the for the first three quarters of 2016/2017 uptake of age 5 pre-school boosters was 90% in quarters one and two and 70% in quarter three.  
  • The premises were suitable for children and babies with baby changing facilities available.
  • Appointments were available outside of school hours and young children were prioritised for appointments.
  • The practice worked with midwives, health visitors and school nurses to support this population group. Ante-natal clinics ran weekly at the practice. The practice also worked with local schools and Sure Start centre (early childhood services) in promoting health.

Older people

Good

Updated 21 June 2017

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

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and same day appointments for those with enhanced needs.
  • Those who were frail or housebound could order their prescriptions by telephone.
  • The practice participated in the admission avoidance scheme to try and prevent admissions to hospital. Monthly clinical meetings were used to discuss those with complex needs or at risk.
  • The practice met with other health professionals to discuss and plan care for some of the practices most vulnerable patients including those with end of life care needs.
  • The practice offered flu, shingles and pneumonia vaccinations to relevant patients.

Working age people (including those recently retired and students)

Good

Updated 21 June 2017

The practice is rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • Extended opening hours on a Tuesday evening and Saturday morning were available for the convenience of patients who worked or had other commitments during usual opening hours.
  • The practice offered telephone consultations.
  • Patients could use online services for booking appointments and ordering repeat prescriptions.
  • Texting was used to remind patients of appointments.
  • The practice was proactive in offering a range of health promotion and screening that reflects the needs for this age group. Patients could access a health promoter who supported patients to maintain healthier lifestyles.
  • The practice signposted patients to various apps they could download on to their phones which promoted health and wellbeing.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 June 2017

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

  • Nationally reported data for 2015/16 showed that 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was above the CCG and national average 84%. There were no exceptions reported.
  • National reported data for 2015/16 showed 94% of patients with poor mental health had comprehensive, agreed care plan documented, in the preceding 12 months which was comparable to the CCG average 91% and national average 89%. Exception reporting was higher at 25% than the CCG average of 15% and national average of 13%.
  • The practice had a named lead for patients with poor mental health and dementia.
  • The practice had access to ‘route 2 wellbeing’ a local online resource which provides information about various support available (which can impact on mental wellbeing)in the Sandwell area including support and advice on finance, housing and bereavement.

People whose circumstances may make them vulnerable

Good

Updated 21 June 2017

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

  • The practice held a registers of patients living in vulnerable circumstances such as those with a learning disability and those with caring responsibilities.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients including those with end of life care needs.
  • The practice offered longer appointments for patients who may need them.
  • Patients with a learning disability were offered the opportunity of a health check, practice data for 2016/17 showed four out of nine patients on the learning disability register had taken up the offer.
  • Patients who were carers were provided with a pack signposting them to various support available and were offered health checks and flu vaccinations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 maintained a taxi and equipment fund to support patients in need.