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Inspection Summary


Overall summary & rating

Good

Updated 10 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Middleport Medical Centre on 26 September 2017. Overall the practice is rated as good.

Middleport Medical Centre was previously registered with the Care Quality Commission (CQC) as a limited company with the provider, Network Healthcare Solutions. A change of provider took place in April 2016. The new provider is General Medical Services Limited. We carried out a comprehensive inspection of Middleport Medical Centre under the previous provider on 12 December 2014 and rated the practice as good. The report for the inspection carried out on 12 December 2014 can be found by selecting the ‘all reports’ link for Middleport Medical Centre on our website at www.cqc.org.uk.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • The practice had effectively worked with the pain management clinic to reduce and manage the high prescribing rate of two medicines that had the potential for misuse.

  • Staff were aware of current evidence based guidance and had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • The practice maintained appropriate standards of cleanliness and hygiene.
  • Appropriate recruitment checks had been undertaken prior to employment although satisfactory information about any physical or mental health conditions relevant to a person’s ability to carry out their role had not been obtained for all staff.
  • Results from the national GP patient survey published in July 2017 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 and the practice proactively acted on complaints posted on the national website, NHS Choices. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients found it easy to make an appointment 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 the management team.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.

We saw one area of outstanding practice:

  • The practice had effectively worked with the pain management clinic to reduce and manage the high prescribing rate of two medicines that had the potential for misuse.

The areas where the provider should make improvement are:

  • Prior to employment, obtain satisfactory information about any physical or mental health conditions relevant to a person’s ability to carry out their role.

  • Update the cold chain policy to provide clear guidance for staff on the safe transportation and administration of vaccines to patients living in care homes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 October 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.

  • The practice had clearly defined and embedded systems, processes and practices to minimise risks to patient safety. However, the cold chain policy did not provide clear guidance for staff on the safe transportation and administration of vaccines to patients living in care homes.

  • The practice had proactively worked with the pain management clinic to reduce and manage the high prescribing rate of medicines that had the potential for misuse.

  • Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • The practice maintained appropriate standards of cleanliness and hygiene. However, cleaning schedules for the cleaning of clinical rooms were not in place.

  • Appropriate recruitment checks had been undertaken prior to employment although satisfactory information about any physical or mental health conditions relevant to a person’s ability to carry out their role had not been obtained for all staff.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 10 October 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) for the previous provider showed patient outcomes were at or above average compared to the national average however there was high exception reporting in some areas. The new provider was aware of these high exception reporting rates and had taken action to reduce them. Unverified QOF data for 2016/17 showed a continual downward trend in exception reporting by the new provider.

  • Staff were aware of current evidence based guidance and had been trained to provide them with the skills and knowledge to deliver effective care and treatment.

  • Clinical audits demonstrated quality improvement.

  • There was evidence of appraisals 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 and when appropriate, information was shared with the out of hours service.

Caring

Good

Updated 10 October 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey published in July 2017 showed patients rated the practice higher than others for several aspects of care. Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Through the comment cards we received, patients told us staff were caring, respectful and went the extra mile to be helpful. They told us they felt listened to by the GPs and the receptionists were very friendly.

  • 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 10 October 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.

  • 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.

  • The results of the national patient survey and comment cards we received showed that patients found it easy to make an appointment 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 the examples we reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 10 October 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 the management team. 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 management team 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 patients through surveys, the family and friends test and the patient participation group.

  • There was a focus on continuous learning and improvement at all levels. Staff were supported to attend training.

  • The lead GP demonstrated a high level of involvement in the local health economy through their involvement with the local Clinical Commissioning Group and GP federation.

Checks on specific services

People with long term conditions

Good

Updated 10 October 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.

  • The percentage of patients with diabetes, on the register, who had their blood pressure reading measured in the preceding 12 months and it was within recognised limits was 82%. This was comparable with the Clinical Commissioning Group (CCG) average of 77% and the national average of 78%.

  • Patients with long term conditions such as diabetes and asthma were provided with a self-management plan and offered an annual review of their health. For those patients with the most complex needs, a GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Vulnerable patients with long term conditions were contacted within two days of post hospital discharge.

Families, children and young people

Good

Updated 10 October 2017

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

  • The practice had a policy to follow up children who failed to attend for hospital appointments and children who had a high number of accident and emergency (A&E) attendances.

  • Immunisation rates were high for all standard childhood immunisations.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

  • The practice held informal, weekly meetings with the health visitor to discuss children in need of additional support.

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

  • The practice provided a ‘Developing All Sexual Health’ (DASH) service for young people aged 15-24 years. This included provision of and education relating to contraception, pregnancy testing and chlamydia screening.

Older people

Good

Updated 10 October 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 followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • The practice provided treatment and care to patients living in four large care homes. The practice held regular multidisciplinary team meetings with the care homes to meet the needs of patients living there.

  • Older housebound patients were offered an annual home visit.

  • The practice offered over 75 year old health checks.

Working age people (including those recently retired and students)

Good

Updated 10 October 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. For example, telephone consultations.

  • The practice was proactive in offering online services for booking GP appointments and ordering of repeat medication. They offered a full range of health promotion and screening that reflected the needs for this age group.

  • The practice offered extended hours appointments until 8pm Monday to Wednesday for working aged patients who could not attend during normal opening hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 10 October 2017

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

  • Data for the previous provider showed that 96% of patients with a diagnosed mental health disorder had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was higher than the CCG and national averages of 89%.

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

  • 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 in place to follow up patients who failed to attend mental health reviews appointments.

  • Data for the previous provider showed that 92% of patients diagnosed with dementia had a care plan in place that had been reviewed in a face-to-face review in the preceding 12 months. This was comparable with the CCG average of 87% and the national average of 84%.

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

People whose circumstances may make them vulnerable

Good

Updated 10 October 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 those with a learning disability.

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

  • Patients with a learning disability were offered an annual health check and provided with longer appointments if needed.

  • 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 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 provided care and treatment for 60 patients with complex neurological problems living in a local care home and provided weekly ward rounds to review their care. All of these patients had a care plan in place which was reviewed regularly. The practice provided a dedicated telephone line for staff working at the home to ensure rapid access to clinical advice during an emergency.