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The Spires Health Centre Good

The provider of this service changed - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 3 July 2018

This practice is rated as Good overall. (Previous inspection June 2017 – Good overall, with requires improvement rating for providing Safe services).

The key question is rated as:

Are services safe? – Good

We carried out a focused inspection at The Spires Health Centre on 1 June 2018. This inspection was in response to previous comprehensive inspection at the practice in June 2017, where breaches of the Health and Social Care Act 2008 were identified. You can read the report from our last comprehensive inspection on 29 June 2017; by selecting the 'all reports' link for The Spires Health Centre on our website at www.cqc.org.uk.

At this inspection we found:

The practice had reviewed their system for receiving and managing alerts including those from the Medical and Healthcare products Regulatory Agency (MHRA) and had strengthened their processes to ensure alerts were managed and actioned appropriately.

The practice had clear systems to manage risk so that safety incidents were less likely to happen. Since the last inspection the practice had completed a range of risk assessments to identify and manage risks appropriately. When incidents did happen, the practice learned from them and improved their processes.

  • The practice had established processes to increase the identification of carers in order to provide further support where needed. This included staff training.
  • A review of the induction programme had been completed to ensure new staff received training on infection prevention and control.
  • A review of the complaints process had been completed to ensure verbal complaints were logged and discussed with the team and to monitor any trends through analysis. The practice also shared relevant complaints through a reporting incident web tool to the clinical commissioning group.
  • The practice continued to try and encourage patients to join the patient participation group and had seen a small increase in patients expressing an interest. The practice had asked the CCG for advice on how to improve patient uptake and notices were on display in the waiting room encouraging patients to join and the date of the next meeting.
  • The practice’s outcomes for national screening programmes continued to be low in comparison to national averages, however the practice was able to demonstrate how they monitored patients’ attendance for screening and they systems they had in place to follow up patients who did not attend.
  • Since the last inspection the practice had reviewed their governance arrangements to ensure they were embedded within the team.
  • The practice had implemented a prescription logging system to ensure all blank prescription pads were recorded before being used for home visits. The practice had also updated their prescription security protocol.

The areas where the provider should make improvements are:

  • Continue to encourage patients to attend screening programmes.
  • Continue to review the process to increase interest in patient participation group.

Professor Steve Field (CBE FRCP FFPH FRCGP)

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 July 2018

At our previous inspection on 29 June 2017, we rated the practice requires improvement for providing safe services as the provider did not have effective systems in place to monitor and mitigate risks to patient and staff safety. This included the actioning of safety alerts and insufficient quantities of emergency medicines to ensure the safety of service users.

We issued a requirement notice in respect of these issues and found arrangements had improved when we undertook a follow up inspection of the service on 1 June 2018. The details of these can be found by selecting the ‘all reports’ link for The Spires Health Centre on our website at www.cqc.org.uk.

At this inspection we found that the improvements the practice had made were sustained and we rated the practice as good for providing safe services.


Safety systems and processes

The practice had clear systems to keep people safe and safeguarded from abuse.

  • The practice had appropriate systems to safeguard children and vulnerable adults from abuse. All staff received up-to-date safeguarding and safety training appropriate to their role. They knew how to identify and report concerns. Reports and learning from safeguarding incidents were available to staff.
  • Staff who acted as chaperones were trained for their role and had received a Disclosure and Barring (DBS) check. (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable.)
  • Staff took steps, including working with other agencies, to protect patients from abuse, neglect, harassment, discrimination and breaches of their dignity and respect.
  • The practice carried out appropriate staff checks at the time of recruitment and on an ongoing basis.
  • There was an effective system to manage infection prevention and control.
  • The practice had arrangements to ensure that facilities and equipment were safe and in good working order.
  • Arrangements for managing waste and clinical specimens kept people safe.

Risks to patients

There were adequate systems to assess, monitor and manage risks to patient safety.

  • Since the last inspection, the practice had reviewed their system for receiving and managing alerts including those from the Medical and Healthcare products Regulatory Agency (MHRA) and had strengthened their processes to ensure alerts were managed and actioned appropriately.
  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • Arrangements were in place for planning and monitoring the number and mix of staff needed to meet patients’ needs, including planning for holidays, sickness, busy periods and epidemics.
  • The practice was equipped to deal with medical emergencies and staff were suitably trained in emergency procedures.
  • Staff understood their responsibilities to manage emergencies on the premises and to recognise those in need of urgent medical attention. Clinicians knew how to identify and manage patients with severe infections including sepsis.
  • When there were changes to services or staff the practice assessed and monitored the impact on safety.

Information to deliver safe care and treatment

Staff had the information they needed to deliver safe care and treatment to patients.

  • The care records we saw showed that information needed to deliver safe care and treatment was available to staff. There was a documented approach to managing test results.
  • The practice had systems for sharing information with staff and other agencies to enable them to deliver safe care and treatment.
  • Clinicians made timely referrals in line with protocols.

Appropriate and safe use of medicines

The practice had reliable systems for appropriate and safe handling of medicines.

  • The systems for managing and storing medicines, including vaccines, medical gases, emergency medicines and equipment, minimised risks.
  • Staff prescribed medicines to patients and gave advice on medicines in line with current national guidance. The practice had reviewed its antibiotic prescribing and taken action to support good antimicrobial stewardship in line with local and national guidance. The practice was in line for antibiotic prescribing with local and national averages.
  • Patients’ health was monitored in relation to the use of medicines and followed up on appropriately. Patients were involved in regular reviews of their medicines.
  • The practice had implemented a prescription logging system to ensure all blank prescription pads were recorded before being used for home visits. The practice had also updated their prescription security protocol.

Track record on safety

The practice had a good track record on safety.

  • There were comprehensive risk assessments in relation to safety issues. Since the last inspection, the practice had completed a range of risk assessments to identify and manage risks appropriately.
  • The practice monitored and reviewed activity. This helped it to understand risks and gave a clear, accurate and current picture of safety that led to safety improvements.

Lessons learned and improvements made

The practice learned and made improvements when things went wrong.

  • Staff understood their duty to raise concerns and report incidents and near misses. Leaders and managers supported them when they did so.
  • There were adequate systems for reviewing and investigating when things went wrong. The practice learned and shared lessons; identified themes and took action to improve safety in the practice.
  • The practice acted on and learned from external safety events as well as patient and medicine safety alerts.


Please refer to the Evidence Table for further information.

Effective

Good

Updated 21 July 2017

  • Data from the Quality and Outcomes Framework showed patient outcomes were comparable to the national average. The latest published results (2015/16) showed the practice had achieved 93% of the points available. The practice used this information to monitor performance against national screening programmes and outcomes for patients.
  • Clinical audits demonstrated quality improvement and the practice carried out regular audits to monitor patient outcomes.
  • The practice had participated in the Clinical Commissioning Group (CCG) primary care commissioning framework, to improve the overall quality of clinical care. The latest results for 2016/17 showed the practice had achieved 98%.
  • There was evidence of appraisals and personal development plans for all staff. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 21 July 2017

  • Data from the most recent national GP patient survey published July 2016 showed patients rated the practice higher than others for several aspects of care in comparison to local averages.
  • 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 and feedback from patients supported these results.
  • Information for patients about the services available was easy to understand and accessible.
  • The practice had a carers register and data provided by the practice showed 0.7% of the practice’s population had been identified as carers. There was a carers information in the waiting room on local support available.

Responsive

Good

Updated 21 July 2017

  • 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.
  • Results from the most recent national GP patient survey showed 72% of patients said they could get through easily to the practice by phone compared to the CCG average of 60% and the national average of 73%.
  • Patients could access appointments and services in a way and at a time that suited them, this included by telephone, online and face to face, with urgent appointments available the same day.
  • Information about how to complain was available and evidence reviewed showed the practice responded quickly to issues raised. Improvements were made to the quality of care as a result of complaints and concerns and complaints were shared with staff at staff meetings which were held every three months.

Well-led

Good

Updated 21 July 2017

  • The practice had a 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 leadership structure and staff felt supported by management.
  • The practice had policies and procedures to govern activity and held regular governance meetings. However the overarching governance framework which supported the delivery of the strategy and quality care was not aways effective in supporting the monitoring of risk.
  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The GPs 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 (PPG).
  • The GPs were skilled in specialist areas and used their expertise to offer additional services to patients. For example, minor surgery and family planning service.

Checks on specific services

People with long term conditions

Good

Updated 21 July 2017

  • The practice nurse had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority. The latest QOF results (2015/16) showed performance for diabetes related indicators was 88% which was comparable to the CCG average of 88% and the national average of 90%.

  • Patients with long-term conditions received annual reviews of their health and medication. 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. We saw evidence that meetings were held every six weeks.
  • The practice supported regular Diabetes in Community Extension (DiCE) clinics with a specialist diabetic nurse every three months.
  • 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.

Families, children and young people

Good

Updated 21 July 2017

  • There were systems in place 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.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice offered a full range of family planning services including Intrauterine Contraceptive Device (IUCD) fittings contraceptive implants.
  • The practice worked with midwives and health visitors to support this population group. For example, the midwife held ante-natal clinics once a week and meetings with the health visitors were held every six weeks.
  • Childhood immunisation rates for under two year olds ranged from 94% to 100% compared to the national average of 90%. Immunisation rates for five year olds ranged from 94% to 100% which were higher than the national average of 88% to 94%.
  • There were policies, procedures and contact numbers to support and guide staff should they have any safeguarding concerns about children.
  • The practice’s uptake for the cervical screening programme was 73% which was lower than the national average of 81%.

Older people

Good

Updated 21 July 2017

  • 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 on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • The practice had participated in the avoiding unplanned admissions scheme which identified elderly vulnerable patients at risk of hospital admission. The practice had seen a reduction in hospital admissions from 10% to 4.7% during the past 12 months and had set up a dedicated phone line for these patients.
  • Older patients were offered vaccinations for flu, pneumonia and shingles. Data provided by the practice showed 75% of patients had received a flu vaccination in comparison to the CCG average of 69%.
  • Documentation provided by the practice showed patients on the palliative care register were discussed at six weekly meetings and their care needs were co-ordinated with community teams. On the day of inspection, we received feedback from the palliative care nurse who told us the practice were very supportive.

Working age people (including those recently retired and students)

Good

Updated 21 July 2017

  • 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, extended opening hours were available early morning and late evening.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflects the needs for this age group.
  • The practice offers NHS health checks for patients aged 40-70 years. Data provided by the practice showed 126 patients had received a health check in the past 12 months.
  • Patients who required support with diet and fitness had access to a health trainer who held support sessions at the practice twice a week.
  • The practice used a stop smoking service, which held clinics at the practice on a weekly basis. Data provided by the practice showed 202 patients had received support to stop smoking and 63 patients had successfully quit smoking within three months.
  • The practice provided an electronic prescribing service (EPS) which enabled GPs to send prescriptions electronically to a pharmacy of the patient’s choice.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 July 2017

  • The latest QOF data (2015/16) showed 78% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was comparable to the national average of 84%.
  • Patients requiring support with mental health needs were referred to the local counselling team who held sessions at the practice on a weekly basis.
  • Unverified data provided by the practice showed 30 patients on the mental health register and the latest QOF data (2015/16) showed 63% of patients had had their care plans reviewed in the last 12 months, which was lower than the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 21 July 2017

  • The practice held a register of vulnerable patients. This included patients with drug and alcohol dependency, patients living with a learning disability, frail patients and those with caring responsibilities and regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice offered longer appointments and annual health checks for people with a learning disability. Unverified data provided by the practice showed 26 patients on the learning disability register and 83% had care plans in place.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations. This included referral to the local drug and alcohol support service which held a clinic once a week at the practice.
  • Staff we spoke with 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’s computer system alerted GPs if a patient was also a carer. There were 33 patients on the practices register for carers; this was 0.7% of the practice list.