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Arden House Medical Practice Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 28 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Arden House Medical Practice on 22 August 2016. The overall rating for the practice was good. Following the inspection the practice sent us an action plan to address a requirement that the provider was not meeting.

The inspection report dated 22 August 2016 can be found by selecting the ‘all reports’ link for

Arden House Medical Practice 

on our website at www.cqc.org.uk.

We carried out a desk based review of

Arden House Medical Practice 

on 31 January 2017, to confirm that the practice had completed their plan to meet the legal requirement we identified at our last inspection. This report covers our findings in relation to the requirement and improvements made.

Our key findings were as follows:

  • The practice had completed their action plan and was now meeting the legal requirement.
  • The arrangements for assessing and managing risks at the practice had been strengthened. 

  • The practice had recently purchased a defibrillator. The equipment was kept at the surgery and would be easily accessible for staff to use in the event of a medical emergency.  All staff had received training on the use of the equipment. 

  • A Legionella risk assessment was carried out on 21 October 2016 

    to identify the risk of exposure of legionella bacteria in the water system

    An action plan and control measures were in place to eliminate and manage the risks identified in the assessment.

  • The chaperone policy had been updated to include the training requirements for staff to undertake this role. All relevant staff who acted as chaperones had received appropriate training to ensure they understood their responsibilities.

  • ​The infection control audit had been updated to include an action plan to complete following an audit. This would provide evidence of action taken to address any improvements identified as a result of an audit.

  • The induction programme for new staff had been updated, to include all essential information to cover the scope of their work. C

    ompleted inductions were signed off by the employee and a relevant senior member of staff, to support that staff had received appropriate training t

    o carry out their role effectively

    .

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 February 2017

At our previous inspection on 22 August 2016, we rated the practice as requires improvement for providing safe services as the arrangements in place to assess and manage risks were not always sufficiently robust.

The desk based review on 31 January 2017 provided us with assurances that the required improvements had been made, and the practice is now rated as good for providing safe services.

  • The arrangements for assessing and managing risks at the practice had been strengthened.
  • The practice had recently purchased a defibrillator. The equipment was kept at the surgery and would be easily accessible for staff to use in the event of a medical emergency. All staff had received training on the use of the equipment.
  • A Legionella risk assessment was carried out on 21 October 2016 to identify the risk of exposure of legionella bacteria in the water system. An action plan and control measures were in place to eliminate and manage the risks identified in the assessment.
  • The chaperone policy had been updated to include the training requirements for staff to undertake this role. All staff who acted as chaperones had received appropriate training to ensure they understood their responsibilities.
  • ​The infection control audit had been updated to include an action plan to complete following an audit. This would provide evidence of action taken to address any improvements identified as a result of an audit.
  • The induction programme for new staff had been updated, to ensure it included all essential information to cover the scope of their work. Completed inductions were signed off by the employee and a relevant senior member of staff, to support that staff had received appropriate training to carry out their role effectively.

Effective

Good

Updated 12 October 2016

  • The practice delivered care in line with relevant and current evidence based guidance and standards, including National Institute for Health and Care Excellence (NICE) best practice guidelines.
  • The practice had acquired a total achievement of 97.3% for the Quality and Outcomes Framework (QOF) 2014-15. This was marginally below the CCG average of 98.1%, and above the national average of 94.7%.
  • The practice worked collaboratively with the wider health and social community to plan and co-ordinate care to meet their patients’ needs at a weekly multi-disciplinary team meeting. An additional monthly meeting held by the practice’s care co-ordinator with the social worker helped to integrate health and social care planning arrangements.
  • Staff had the skills and experience to deliver effective care and treatment. New employees received inductions, and all members of the practice team had received an appraisal in the last year, which included a review of their training needs.
  • The practice received regular input from a community pharmacist and a CCG medicines management technician to provide support on medicines and prescribing matters.
  • We saw examples of how clinical audit was being used to improve quality and enhance safe patient care and treatment.

Caring

Good

Updated 12 October 2016

  • We observed a patient-centred culture and approach within the practice. Staff treated patients respectfully and with kindness.
  • Data from the latest GP survey in July 2016 showed that patients rated the practice higher than local and national averages in respect of the care they received.
  • Patients we spoke with during the inspection, and feedback received on our comments cards, indicated that they felt treated with compassion and dignity, and were given sufficient time during consultations. Patients said they were involved in decisions about their care and treatment.
  • Feedback received from care home staff and a member of the community nursing team was positive about the high standards of care provided by the practice team.
  • The practice had identified 2% of their list as being carers, which was in line with expected averages. Information was available on the various types of support available to carers. The practice was not providing any specific services or support for carers apart from their inclusion in the annual flu vaccination programme.
  • We were informed of examples in which the practice had provided high levels of care to individual patients. This included the ongoing support and care for a patient with a learning disability, and the support given to a patient who was now able to self-manage their condition following extensive input initially from the practice team.
  • As a small semi-rural practice, the team knew their patients very well. This aided them in providing personalised care and ensured greater continuity for patients.

Responsive

Good

Updated 12 October 2016

  • Comment cards and patients we spoke with during the inspection provided consistently positive experiences about obtaining an appointment with a GP. The latest GP survey showed that patient satisfaction was significantly above local and national averages with regards access to GP appointments.
  • There was in-built flexibility within the appointment system including pre-bookable slots; telephone consultations; and ‘on the day’ urgent appointments.
  • Patients could book appointments and order repeat prescriptions on line. The practice participated in the electronic prescribing scheme, so that patients could collect their medicines from their preferred pharmacy without having to collect the prescription from the practice.
  • The practice hosted some services on site including a hearing assessment clinic and a weekly Citizens Advice Bureau session. This made it easier for their patients to access services locally.
  • The practice implemented improvements and made changes to the way it delivered services as a consequence of feedback from patients.
  • The premises were tidy and clean and well-equipped to treat patients and meet their needs. The practice accommodated the needs of patients with disabilities, including access to the building through automatic doors.
  • The practice reviewed any complaints they received and dealt with these in a sensitive and timely manner. Information about how to make a complaint was available for patients. Learning from complaints was used to improve the quality of service.
  • If patients at reception wished to talk confidentially, or became distressed, they could be offered a more private area to ensure their privacy.

Well-led

Good

Updated 12 October 2016

  • The partners were committed to delivering high quality care and promoting good outcomes for their patients.
  • There was a clear staffing structure in place. GPs and nurses had lead roles providing a source of support and expert advice for their colleagues.
  • The practice had developed a range of policies and procedures to govern activity.
  • The partners worked collaboratively with other GP practices in their locality, and with their CCG. They were proactively engaged with the CCG’s strategy to deliver care closer to people’s homes.
  • The partners reviewed comparative data provided by their CCG and ensured actions were implemented to address any areas of outlying performance.
  • Staff felt well supported by management, and the practice held regular staff meetings.
  • The practice had sought feedback from patients, and acted on this to improve service delivery. The practice did not have an active patient participation group (PPG) at the time of our inspection.
Checks on specific services

People with long term conditions

Good

Updated 12 October 2016

  • The practice undertook annual reviews for patients on their long-term conditions registers, including a review of their prescribed medicines. These were undertaken more frequently for individual patients that had more complex needs.
  • QOF achievements for clinical indicators were in line with CCG and averages, and slightly above national averages. For example, the practice achieved 97.7% for diabetes related indicators, in comparison to local and national averages of 96.7% and 89.2% respectively.
  • The recall system was co-ordinated by the administration team who undertook monthly searches and followed-up any patients that were overdue.
  • Patients with multiple conditions were usually reviewed in one appointment to avoid them having to make several visits to the practice. The appointment was extended by up to 45 minutes to accommodate this.
  • There was a lead designated GP or nurse for all the clinical domains within QOF.
  • A specialist diabetes nurse attended the practice occasionally to undertake a joint clinic with the practice nurse to manage complex patients with diabetes. Patients had been allocated up to one hour’s appointment time to facilitate this review. In addition, the practice undertook foot checks for low-risk patients with diabetes, and also held a fortnightly eye clinic to assess the sight of patients who had diabetes.
  • All patients with a long-term condition were offered an annual flu vaccination. Patients were contacted individually to arrange an appointment to ensure the highest possible uptake.

Families, children and young people

Good

Updated 12 October 2016

  • Same day rapid access was provided for unwell babies or children. Routine appointments for children were available outside of school hours.
  • The GPs saw new mothers for a post-natal review and a six-week baby check.
  • Childhood immunisation rates were in line with local averages. Rates for the vaccinations given to children up to five years of age ranged from 69.4% to 100% (local averages 95.2% to 99.1%). Non-attendance was followed up and cases would be referred to the health visitor if that had been repeated non-engagement.
  • The practice had an identified lead GP for child safeguarding. The health visitor and school nurse attended the practice multi-disciplinary team meetings on a monthly basis to review and discuss any child safeguarding concerns. Child protection alerts were used on the clinical system to ensure clinicians were able to actively monitor any concerns.
  • Family planning services were provided including the provision of long-acting reversible contraceptives and advice and support on all aspects of contraception. Patients could access a family planning clinic in New Mills to fit and remove intrauterine devices (coils). Chlamydia screening kits were available in corridors.
  • The practice worked within their local community to promote health – for example, children from a local nursery had visited the practice to increase their understanding about going to see a doctor. A GP had given a talk to schoolchildren about the doctor’s surgery.
  • The practice had baby changing facilities, and welcomed mothers who wished to breastfeed on site. A private room could be offered for breastfeeding mothers if this was requested, and information was available on local breastfeeding groups.

Older people

Good

Updated 12 October 2016

  • The practice directly employed their own community matron and care co-ordinator. This facilitated care for patients being discharged from hospital, or provided support to help patients remain in their own home.
  • The needs of older people with more complex needs were reviewed at a weekly multi-disciplinary team meeting. The care co-ordinator met monthly with the social worker to review individual patients in greater depth. This helped to integrate the health and social needs for patients to produce a more comprehensive and personalised package of care.
  • Longer appointment times could be arranged for those patients with complex care needs, and home visits were available for those unable to attend the surgery.
  • The practice pharmacist and matron undertook medicines reviews for those patients that were housebound. The pharmacist also reviewed the use of multiple prescribed medicines.
  • Uptake of the flu vaccination for patients aged over 65 was 70.8%, which was in line with local (73.9%) and national (70.5%) averages.

Working age people (including those recently retired and students)

Good

Updated 12 October 2016

  • The practice offered on-line booking for appointments and requests for repeat prescriptions. The practice provided electronic prescribing so that patients on repeat medicines could collect them directly from their preferred pharmacy.
  • Telephone consultations were available meaning that patients did not have to travel to the practice unnecessarily.
  • The practice promoted health screening programmes to keep patients safe. NHS health checks were available.
  • The practice did not offer any extended hours consultations at the time of our inspection. However, feedback from patients was overwhelming positive about obtaining a GP appointment.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 October 2016

  • The practice achieved 100% for mental health related indicators in QOF, which was 1.9% above the CCG and 7.2% above the national averages. Exception reporting rates for mental health related indicators were generally slightly higher than local and national rates.
  • 93.3% of patients with severe and enduring mental health problems had a comprehensive care plan documented in the preceding 12 months according to 2014-15 QOF data. This was in alignment with the CCG average and 5% above the national average of 88.5%.
  • Although there was no access to counselling or associated talking therapies’ services on site, patients could access services in nearby Buxton or Whaley Bridge.
  • The practice worked with local community mental health teams and had established a good relationship with the community psychiatric nurse (CPN), who regularly attended the multi-disciplinary team meetings.
  • The practice reviewed patients who had attended hospital for issues relating to self-harm.
  • The practice carefully monitored patients who were taking high-risk medicines for their mental health condition.
  • 88.5% of people diagnosed with dementia had had their care reviewed in a face-to-face meeting in the last 12 months. This was higher than local and national averages by approximately 4.5%. Exception reporting rates were also lower at 3.7%, compared to the local and national average of 8.3%.

People whose circumstances may make them vulnerable

Good

Updated 12 October 2016

  • The practice had undertaken an annual health review in the last 12 months for 79.3% of patients with a learning disability. The remaining patients declined the assessment.
  • The practice had a higher prevalence of registered patients with a learning disability as they covered two residential homes for this patient group. The practice had a dedicated nurse to lead on patients with a learning disability who visited each home weekly and reviewed all patients on a quarterly basis. All these patients had a care plan in place.
  • The lead nurse for learning disabilities liaised with the learning disabilities specialist nurse whenever any challenging issues required an expert view.
  • A GP partner was accredited as a GP with a Special Interest (GPwSI) in substance misuse and worked with the local substance misuse service to provide support for patients. This service was available to all local residents, and not just for registered patients.
  • Patients with end-of-life care needs were reviewed at weekly multi-disciplinary team meetings. The practice worked closely with the district nursing team to deliver responsive care to these patients.
  • The practice referred or signposted patients to the ‘Wrap-around Care Project’ funded by their CCG. This provided a point of first contact for health professionals to access the voluntary sector within the locality. Service available included befriending, transport and shopping with the aim of keeping people independent in their own homes, or to regain confidence following a hospital discharge.
  • Staff had received adult safeguarding training and were aware how to report any concerns relating to vulnerable patients. There was a designated lead GP for adult safeguarding.
  • The practice was a recognised safe haven for people with a learning disability. This Derbyshire partnership scheme aimed to protect people with learning disabilities from potential bullying or abuse, and helped them feel safe and confident within the community by having access to a place where they could be supported if required.
  • Longer appointments and home visits were available for vulnerable patients.