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Eltham Medical Practice Good

This service was previously registered at a different address - see old profile

Inspection Summary


Overall summary & rating

Good

Updated 20 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Eltham Medical Practice on 17 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.
  • Staff had received training on safeguarding children and vulnerable adults relevant to their role. They understood their responsibilities; however, not all staff spoken to were aware of external safeguarding agencies.
  • The arrangements for managing medicines, including emergency medicines and vaccines, in the practice had been improved and minimised risks to patient safety. However, we noted that the practice did not stock some of the recommended emergency drugs.
  • Fire safety measures at the main site were the responsibility of the building owners. The practice had not considered the potential benefits of periodically reviewing the level of fire safety awareness within their own staff team.
  • The practice provided us with two audits completed in the last three years. These showed limited evidence of quality improvement.
  • There were panic alarms in all the consultation and treatment rooms which alerted staff to any emergency. There was also an emergency/panic button in the reception area; however we were informed this had not been enabled. The potential risk this posed to staff had not been assessed.
  • 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 felt they were treated with compassion, dignity and respect. The practice was comparable to local and national outcomes for its satisfaction scores on consultations with GPs and nurses.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • We noted that there was no effective safety net in place to ensure blood tests arranged by the nurse practitioner were followed up.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. However, the practice asked that all complaints be made in writing contrary to current regulations.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was comparable to local and national averages.
  • 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 areas where the provider should make improvement are:

  • Review practice emergency arrangements, specifically relating to emergency medicines; fire safety and panic alarms.
  • Ensure staff are aware of external safeguarding agencies, and when they might use them.

  • The provider should continue to consider the quality of care provided; review the care provided in relation to current best practice guidance; make changes where necessary or appropriate in order to improve and revisit the question to see whether the changes made have resulted in an improvement.
  • Review the blood test follow up system used by the nurse practitioner, to minimise the risk to patients that results were not followed up.
  • Ensure the complaints process is in line with legislative requirements such as signposting the Ombudsman in the practice’s decision letter, accepting oral complaints and ensuring complainants receive suitable support and advice, or signposting to them.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 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; in most instances lessons were shared to make sure action was taken to improve safety in the practice. When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The arrangements for managing medicines, including emergency medicines and vaccines, in the practice had been improved and minimised risks to patient safety. However, we noted that the practice did not stock some of the recommended emergency drugs.
  • Staff had received training on safeguarding children and vulnerable adults relevant to their role. They understood their responsibilities; however, not all staff spoken to were aware of external safeguarding agencies.
  • The practice provided us with two audits completed in the last three years. These showed limited evidence of quality improvement.
  • The practice had arrangements to respond to emergencies and major incidents; however, in some areas these could be improved.
  • We saw the branch site fire alarm system was checked weekly, and regular fire drills were carried out. We were informed that responsibility for fire safety at the main site was the responsibility of the building owners and that they maintained the fire fighting /detection equipment and conducted whole building drills (the building was shared with another GP practice and the community hospital). The practice had not considered the potential benefits of periodically reviewing the level of fire safety awareness within their own staff team.
  • There were panic alarms in all the consultation and treatment rooms which alerted staff to any emergency. There was also an emergency/panic button in the reception area; however, we were informed it was not enabled. The potential risk this posed to staff had not been assessed.

Effective

Good

Updated 20 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were mixed. Some were at or above average compared to the national average but several were below.
  • Staff were aware of current evidence based guidance.
  • There was minimal evidence of a quality improvement programme.
  • Staff had the skills and knowledge to deliver effective care and treatment. The practice could demonstrate how they ensured role-specific training and updating for relevant staff. For example, nurses undertaking cervical smears underwent annual refresher training.
  • 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.
  • We noted that there was no effective safety net in place to ensure blood tests arranged by the nurse practitioner were followed up.

Caring

Good

Updated 20 July 2017

The practice is rated as good for providing caring services.

  • Results from the national GP patient survey showed patients felt they were treated with compassion, dignity and respect. The practice was comparable for its satisfaction scores on consultations with GPs and nurses.
  • 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.
  • Patients responded positively to questions about the GPs involving them in planning and making decisions about their care; but were less positive about the nurses.
  • 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 20 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 it offered extended hours at the branch site on a Tuesday and Thursday evening until 8.00pm and on Thursday mornings from 7.00am, for working patients who could not attend during normal opening hours.
  • 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 national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was comparable to local and national averages.
  • 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 nine examples reviewed showed the practice responded quickly to issues raised. However, the practice asked that all complaints be made in writing, contrary to current regulations .
  • Learning from most complaints was shared with staff.

Well-led

Good

Updated 20 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 inductions, annual performance reviews and attended staff meetings and training opportunities.
  • The provider was aware of the requirements of the duty of candour. In four examples we reviewed we saw evidence the practice complied with these requirements.
  • The partners 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.
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 20 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.
  • Performance for diabetes related indicators was higher than the CCG and/or national averages.
  • The practice offered a range of testing on site, including blood tests, spirometry, ECGs and APBM (Ambulatory Blood Pressure Monitoring).
  • 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 care professionals to deliver a multidisciplinary package of care.
  • Patients who failed to attend for management of their condition were followed up with a telephone call or letter; and text reminders for appointments were sent.

Families, children and young people

Good

Updated 20 July 2017

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

  • We found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice provided a dedicated baby clinic which offered the eight week baby check, first immunisations and a post-natal check for the mother in a single appointment.
  • The practice reserved a minimum of two slots per clinician at the end of the morning surgery to ensure children were seen promptly.
  • A family planning clinic was available, which offered coils and implants.

Older people

Good

Updated 20 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. It maintained a palliative care register. There were 48 patients on this register, all of whose care had been reviewed in the past year.
  • The practice liaised with community services such as the rapid medical assessment team and the community rehabilitation team to enhance the care provided.
  • Regular multidisciplinary team meetings were held with member of staff from, for example, the district nurses, and the community heart failure and COPD (chronic obstructive pulmonary disease) teams.

Working age people (including those recently retired and students)

Good

Updated 20 July 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, extended opening hours in the morning and 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.

  • Telephone consultations were available for those patients who felt their needs could be met over the phone.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 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.
  • 81% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is slightly lower than the comparable to the national average of 84% and CCG average of 87%.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. There were 122 patients on the mental health register, of whom 111 had received an annual review in the last year.
  • 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 a dedicated mental health lead nurse. Patients with complex needs were offered longer appointments.

People whose circumstances may make them vulnerable

Good

Updated 20 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 those with a learning disability. There were 53 patients on the learning disability register, of whom 34 had received an annual review in the last year. All patients had been invited to an annual review; and those who did not received a follow up phone call again inviting them to attend.
  • Homeless patients were enabled to register.
  • End of life care was delivered in a coordinated way which 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 there was a nominated lead for learning disabilities.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • 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.