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Inspection Summary


Overall summary & rating

Good

Updated 29 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Regent Medical Centre on 10 January 2017. Overall, the practice is rated as good.

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

  • Staff understood their responsibilities to raise concerns and report incidents and near misses to the practice manager.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • 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.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • Results for the National GP Survey, published in July 2016, were above local and national averages access to services. For example, for those that responded, 96% found it easy to get thorough to the surgery by phone (CCG average 79%, national average 73%).
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had a clear vision and strategy that all members of staff were involved in reviewing and developing.
  • 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 regulation.

We saw four areas of outstanding practice:

  • Feedback from patients and carers we spoke to was continually positive about the way that staff treated people. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw a strong patient-centred culture. We heard of many examples where staff had gone the extra mile, for example delivering prescriptions when patients were unable to collect prescriptions, seeing patients outside normal clinical session times and taking steps to ensure vulnerable patients, such as patients with learning disabilities, had continuity of care.
  • Data showed that patients rated the practice higher than others for several aspects of care. According to the latest National GP Patient Survey results, 81% of respondents said they usually get to see their preferred GP (CCG average 61%, national average 59%). Data from the most recent Friends and Family Survey carried out by the practice, from September 2016 to November 2016, showed that 100% of patients said they would be extremely likely or likely to recommend the service to family and friends.
  • The practice introduced a review of patients with long-term conditions who did not attend for review appointments into their monthly clinical meeting following an incident. Following a whole team discussion, each non-attender was proactively followed up. Since this review was introduced 73% of the patients discussed had been subsequently seen by a clinician for a review of their chronic disease. The practice planned a formal audit of this work when it had been in place for 12 months.
  • The practice had worked to improve the outcomes for patients. For example, monthly unplanned admission meetings had been introduced as part of a local CCG project; this meeting included attached staff such as district nurses and the community matron. At these meetings, patients were discussed and comprehensive care plans were developed when required. A review of data showed that for 2015, 18% of these admissions had been deemed as avoidable, for 2016, only 4% of these admissions had been deemed avoidable. In addition the practice had introduced the palliative care ‘Gold Standards Framework’. As part of this, they had completed work to increase the identification of patients on their palliative care register over the last 12 months. This had resulted in an increase from 9.5% to 44% of patients on this register because of a diagnosis other than cancer. This encouraged the discussion about all patients requiring end of life care at the monthly multi-disciplinary team (MDT) meetings.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 March 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording incidents.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes and prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. For example, there was an effective safety alert system and safeguarding leads were in place.
  • Good infection control arrangements were in place and the practice was clean and hygienic. Disclosure and Barring Service (DBS) checks had been completed for all staff that required them.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 29 March 2017

The practice is rated as good for providing effective services.

  • We found that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • The practice introduced a review of patients with long-term conditions who did not attend for review appointments into their monthly clinical meeting following an incident. Since this review was introduced 73% of the patients discussed had been subsequently seen by a clinician for a review of their chronic disease.
  • The practice had introduced the palliative care ‘Gold Standards Framework’. As part of this, they had completed work to increase the identification of patients on their palliative care register over the last 12 months. This had resulted in an increase from 9.5% to 44% of patients on this register because of a diagnosis other than cancer.
  • Outcomes for patients were above average for the locality. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness and had achieved 98.1% of the points available in 2015/2016. This was 1.2% above the local average and 2.7% above the national average.
  • Quality improvement work was taking place, including clinical audit.
  • 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.

Caring

Outstanding

Updated 29 March 2017

The practice is rated as outstanding for providing caring services.

  • Data showed that patients rated the practice better than others for several aspects of care. For example, results from the National GP Patient Survey, published in July 2016, showed that 99% of respondents said the last GP they saw or spoke to was good at listening to them (CCG average 91%, national average 89%). It also showed that 99% of respondents had confidence and trust in the last GP they saw or spoke to (CCG average 96%, national average 95%).
  • Data from the most recent Friends and Family Survey carried out by the practice, from September 2016 to November 2016, showed that, from 20 respondents, 100% of patients said they would be extremely likely or likely to recommend the service to family and friends.
  • Feedback from patients and carers we spoke to was continually positive about the way that staff treated people. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. We saw a strong patient-centred culture. We heard of many examples where staff had gone the extra mile, for example delivering prescriptions when patients were unable to collect prescriptions, seeing patients outside normal clinical session times and taking steps to ensure vulnerable patients, such as patients with learning disabilities, had continuity of care.
  • As part of a local cluster of practices, funding had been allocated to local projects that focused on social inclusion and support for carers.
  • Information for patients about the services offered by the practice was available; they provided this information on the practice’s website, patient leaflets and in folders in the waiting area that ensured patients could find information on sensitive issues without being overlooked by other patients.
  • The practice had close links to local and national support organisations and referred patients when appropriate.
  • The practice had recently reviewed their carers register to ensure carers were offered appropriate support. A ‘carers corner’ had been set up in a quiet waiting area and the carers champion wrote to all carers detailing to support and advice they could offer.
  • The practice had worked to improve the number of carers they had identified, during 2015/2016 they had identified 29 carers. When we inspected the practice, they had identified 49 carers, which was 1.3% of the practice patient population.

Responsive

Good

Updated 29 March 2017

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs. We saw that the practice had a proactive approach to understating the needs of their patients and to delivering care in a way that met these needs and promoted equality.
  • One of the GP’s at the practice delivered education sessions twice a year. These sessions were open to anyone who wished to attend and not restricted to patients. Topics covered included mental health, prostate awareness and in December 2016 an open session for anyone who was experiencing loneliness at Christmas. The practice consulted with their patient participation group on possible topics.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • Data from the National GP Patient Survey, published in July 2016, showed that patients rated the practice above average for access to care and treatment. For example, of those that responded 88% found it easy to get through to the practice by telephone (CCG average 79%, national average 73%) and 87% described their experience of making an appointment as good (CCG average 76%, national average 73%).
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available on the practice website and in the waiting areas.

Well-led

Good

Updated 29 March 2017

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

  • The practice had a clear vision with quality and safety as their top priority. Staff were clear about the vision and their responsibilities in relation to this. On the day of the inspection, we saw that all staff were committed to this aim, staff had been involved in the development and review of the practices vision.
  • 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.
  • The provider was aware of and complied with the requirements of the duty of candour regulation. 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.
  • 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.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • There was an active patient participation group (PPG) and the practice had acted on feedback from the group.
  • The leadership drove continuous improvement. There was a clear proactive approach to seeking and embedding new ways of providing care and treatment.
Checks on specific services

People with long term conditions

Good

Updated 29 March 2017

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

  • The practice nurses had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority and supported by the practice, comprehensive care plans were in place and regularly reviewed.
  • The practice introduced a review of patients with long-term conditions who had not attended for review appointments into the monthly clinical meeting following an incident. Since this review was introduced 73% of the patients discussed had been subsequently seen by a clinician for a review of their chronic disease.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in this population group were generally above or in line with local and national averages. For example, the practice had achieved 91.3% of the QOF points available for providing the recommended care and treatment for patients with diabetes. This was 2.2% below the local CCG average and 1.5% above the national average.
  • The practice had recently introduced a ‘year of care’ approach for diabetes.
  • Home visits were available when needed. Longer appointments were available if requested.
  • All patients with a long-term condition had a named GP and were offered 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.
  • The practice held regular clinics for long terms conditions, for example for patients with diabetes.

Families, children and young people

Good

Updated 29 March 2017

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

  • There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were arrangements for new babies to receive the immunisations they needed. Practice childhood immunisation rates were above national averages. The practice had scored 9.7/10 compared with the national average score of 9.1/10 in respect of the vaccinations given to two year olds.
  • Pregnant women were able to access an ante-natal clinic provided by healthcare staff attached to the practice.

  • Nationally reported data showed that outcomes for patients with asthma were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma. This was 2.1% above the local CCG average and 2.6% above the national average.

  • The practice provided contraceptive and sexual health advice.
  • Telephone appointments were available at the practice.
  • The practice ensured young people were aware of what the practice could offer and their rights regarding access and consent. The practice wrote to all patients over the age of 16 with information on the services it offered for young people.

Older people

Good

Updated 29 March 2017

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 their population. All patients over the age of 75, who were not on a chronic disease register, were offered an annual health check with a nurse. Since this was introduced in 2016, 49 patients had attended for a health check.

  • The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs. The local CCG pharmacist visited patients in care homes and patients unable to leave the house due to illness and/or old age to carry out medication reviews.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in older people were generally above local and national averages. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with chronic obstructive pulmonary disease (COPD). This was 2.3% above the local clinical commissioning group (CCG) average and 4.1% above the national average.
  • The practice maintained a palliative care register and offered immunisations for shingles and pneumonia to older people.

Working age people (including those recently retired and students)

Good

Updated 29 March 2017

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 website enabled patients to completed online asthma, depression and alcohol questionnaires. Submitted questionnaires were received by the practice manager and then reviewed by a clinician.
  • Patients could order repeat prescriptions and book routine healthcare appointments online.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group.
  • The practice’s uptake for cervical screening was 87.4%, compared to the CCG average of 82.4% and the national average of 81.4%.
  • Additional services such as new patient health checks, travel vaccinations and joint injections were available.
  • A text message appointment reminder service was available.
  • The practice website provided a good range of health promotion advice and information; it also had a facility to translate its contents into many languages.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 March 2017

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

  • The practice had identified 1% of their population with enduring mental health conditions on a patient register to enable them to plan and deliver relevant services. Thirty-six patients were on this register, 64% of those had had an annual review, 28% had an influenza vaccination (2016/2017 data from the practice, which is yet to be verified).
  • Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 99.8% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 4.8% above the local CCG average and 7% above the national average.
  • Nationally reported data showed that outcomes for patients with dementia were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 2.4% above the local CCG average and 3.4% above the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. They 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • Staff had completed dementia awareness training to ensure they were aware of their patient’s needs.

People whose circumstances may make them vulnerable

Good

Updated 29 March 2017

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 patients with a learning disability. Patients with learning disabilities had been invited to the practice for an annual health check. Twenty patients were on this register, 95% had an annual review and 75% had an influenza vaccination (2016/2017 data from the practice, which had not yet been verified).
  • Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.3% above the national average.
  • The practice used ‘easy read’ letters and appropriate health related information that ensured patients can understand the tests and treatment they were offered. The practice had an ‘easy read’ version of the complaints policy, which was available in the waiting area.
  • The practice offered longer appointments for patients with a learning disability if requested.
  • The practice regularly worked with multi-disciplinary teams (MDT) in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff had completed learning disability awareness training to ensure they were aware of their patient’s needs.
  • 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.
  • Good arrangements were in place to support patients who were carers.