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Inspection Summary


Overall summary & rating

Good

Updated 18 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at 3D Medical Centre on 31 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.
  • Patients we spoke with 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.
  • 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 had a proactive patient participation group (PPG).

  • The practice offered staff flexible working across different SSP locations.

  • The practice held a café /drop-in social event each month to bring patients together and reduce social isolation especially in older patients.    

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 July 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. Staff informed patients about things that had gone wrong as soon as practicable. They received reasonable support, truthful information, and a written apology. Staff told patients 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 18 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

  • Staff were aware of current evidence based guidance.

  • Information about patients’ outcomes was identified through data collections that had been routinely carried out in relation to a number of areas including consultations, appointments and inadequate smears.

  • The practice routinely gathered data on important clinical issues and reviewed its performance against appropriate criteria to monitor the effectiveness of clinical care.

  • Staff had the skills and knowledge 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.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 18 July 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several 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.

  • The staff held charity events to encourage patients to come together and to help reduce social isolation.For example, a recent baking event raised money for a local cancer care charity.

  • The practice had a proactive patient participation group (PPG) who supported the community and patients.

  • There was a staff member nominated as the dedicated carers’ champion who maintained a carers’ register and provided support and information about local support services.

Responsive

Good

Updated 18 July 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, health care information was provided in different languages. Patients had free access to a gym that was paid for and set up by the SSP organisation and regular coffee mornings were held to encourage patients to come together and to help reduce social isolation.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • Patients we spoke with 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.

  • 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. Staff leaned from complaints and shared information with other stakeholders.

Well-led

Good

Updated 18 July 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 the vision and their responsibilities in relation to it.

  • 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 induction training, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour. In the examples we reviewed we saw evidence the practice complied with these requirements.
  • The practice 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. The practice engaged with the patient participation group.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.

Checks on specific services

People with long term conditions

Good

Updated 18 July 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • Planned home visits coincided with flu/pneumococcal immunisations

  • The percentage of patients with diabetes, on the register, whose last measured total cholesterol (measured within the preceding 12 months) was 5 mmol/l or less was 79% which was similar to the CCG and the national average.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs. Rescue packs were prepared in advance for patients with chronic obstructive pulmonary disease to reduce the risk of hospital admission.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • All these patients had a named GP and there was a system to recall patients for 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 social care professionals to deliver a multidisciplinary package of care.

  • GPs encouraged at risk family members to be screened for possible genetic long term conditions.

  • Longer appointments, up to 45 minutes, were available for patients with multiple conditions for their convenience and to ensure time was available for a more holistic review of their care needs.

  • Staff provided patients with information about local support services. For example, the alcohol / drug recovery team BIDAS and Think Positive an organisation that provided help to people with anxiety, depression and other similar difficulties.

  • A carer and cancer champion maintained a register of patients with long-term conditions and cancer and provided them with information about local community and practice support services.

Families, children and young people

Good

Updated 18 July 2017

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

  • From the sample of documented examples we reviewed we found there were systems 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 accident and emergency (A&E) attendances.

  • Staff attended regular safeguarding meetings where they were updated on the safeguarding issues within practice.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • The premises were suitable for children and babies. For example, breast feeding and changing facilities were available.

  • Appointments outside of school hours were available.

  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, antenatal and postnatal clinics were held.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

  • An Early Years fact sheet was sent to new parents providing information about vaccination schedules, breast-feeding, cervical screening and other health related information to support and promote health and wellbeing. This factsheet was available in different languages to support patients whose first language was not English.

  • Same day appointments were available for children to reduce potential anxiety for parents and reduce the need to access accident and emergency and out of hours’ services.

  • Weekly and ad-hoc baby immunisation clinics and 8 weeks baby checks were available.

  • The practice offered advice on contraception and sexual health and took part in the RU Clear Chlamydia screening

Older people

Good

Updated 18 July 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 urgent appointments for those with enhanced needs.

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Where older patients had complex needs, the practice shared summary care records with local care services.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible. For example, regular coffee mornings were held at the surgery to encourage patients to meet up in order to reduce social isolation.

  • All patients had a named accountable GP.

  • There was a dedicated carers’ champion who maintained a register of these patients and signposted them to community support services.

  • There was a dedicated telephone line for older patients and outside agencies i.e. the ambulance service and for patients on the hospital unplanned admission register.

Working age people (including those recently retired and students)

Good

Updated 18 July 2017

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

  • The needs of this population group had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, providing health care information in different languages and holding a café /drop-in social event to help reduce social isolation. Staff had identified social isolation as becoming more prevalent amongst patients at the practice.

  • 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 a health check to all registered patients and NHS Health checks every 5 years for those patients between the ages of 40 – 74 years of age.

  • Appointments could be booked online. Telephone appointments were available daily with the nurse and GPs. Repeat prescriptions could be ordered online

  • Patients were able to use the ‘Text to Cancel’ service allowing patients to cancel unwanted appointments. This improved access to appointments for other patients and reduced the rate of missed appointments.

  • Minor surgery injections were offered at the practice

  • The practice worked with local pharmacies to ensure patients could use a pharmacy of their choice for ordering and collection of medicines.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 July 2017

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

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

  • The practice considered the physical health needs of patients with poor mental health and dementia. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a record of blood pressure in the preceding 12 months was 100% which was 17% above the CCG average and 19% above the national average.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

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

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • Opportunistic screening of patients physical health care was discussed and provided to patients during pre-booked appointments

  • The ‘Single Point of Access’ accepted non-urgent referrals and urgent referrals for patients in crisis.

People whose circumstances may make them vulnerable

Good

Updated 18 July 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 homeless people and those with a learning disability.

  • End of life care was delivered in a coordinated way that took into account the needs of those whose circumstances may make them vulnerable.

  • The practice offered longer appointments for patients with a learning disability and mental health problems so they had more time to discuss their health care issues.

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

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They understood their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.

  • All staff were trained in safeguarding. The IT system alerted staff to patients subject to safeguarding.

  • Regular safeguarding meetings took place to ensure these patients received the support and medical treatments they needed.

  • Staff were trained to act as chaperones.

  • The practice was accredited by the LGBT Foundation for its services provided to LGBT patients.

  • Wheelchair access was available and leaflets were printed in large font for patients who were partially sighted.

  • Health promotion materials were available in a range of different languages and a language interpretation service was used.

  • 3 D Medical Centre held education events to ensure patients understand how the surgery worked and to help them feel supported and confident in accessing community services such as the Bolton drug and alcohol service.