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Inspection Summary


Overall summary & rating

Good

Updated 24 January 2018

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Talke Clinic on 27 June 2017. The overall rating for the practice was good with requires improvement for providing safe care and treatment. The full comprehensive report on the June 2017 inspection can be found by selecting the ‘all reports’ link for Talke Clinic on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 8 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment, that we identified in our previous inspection on 27 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good and good for providing safe care and treatment and for all population groups.

Our key findings were as follows:

  • There was an effective system to monitor that all important clinical test requests were reviewed and followed up.

  • The practice’s policy for safeguarding vulnerable adults reflected current guidance.

  • The practice’s recruitment policy reflected legally required recruitment information.

  • Repeat prescriptions were issued within their authorisation duration.

  • An effective system to formally review blood test results before patients were issued repeat prescriptions for warfarin was in place.

  • There was an on-going system to act on a Medicines and Healthcare products Regulatory Agency (MHRA) alert for two medicines used in the treatment of heart failure.

  • The advanced nurse practitioner was supported in their extended role by a GP through monthly patient care reflective accounts.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 24 January 2018

Effective

Good

Updated 24 January 2018

Caring

Good

Updated 24 January 2018

Responsive

Good

Updated 24 January 2018

Well-led

Good

Updated 24 January 2018

Checks on specific services

People with long term conditions

Good

Updated 25 July 2017

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

  • 2015/16 data for the previous provider showed t

    he 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 64%. Current unverified data on the practice’s computer system demonstrated this had significantly improved to 80%.

  • 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.

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

  • 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.

  • The practice offered holistic reviews for patients with long term conditions rather than separate disease clinics in order that patients could have all their conditions reviewed at one appointment.

  • The practice monitored hospital discharges and A&E attendances to identify patients with potential exacerbations of long term conditions. Patients identified were offered an appointment with a GP or nurse for a review and/or extra monitoring of their condition.

  • The practice nurse offered home visits for patients who could not attend the practice for a review of their long term condition.

Families, children and young people

Good

Updated 25 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. The practice had a system in place to monitor and respond to children who failed to attend for hospital appointments or frequently attended A&E.

  • Immunisation rates were relatively 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, the practice held regular safeguarding meetings with the Health Visitor.

  • In May 2017 the practice had participated in Sun Awareness week by providing information to patients within the practice. They also provided sun cream and information leaflets to local schools and nurseries promoting adequate use of sun cream to protect against sunburn.

  • Same day appointments were available for children and those patients with medical problems that require same day consultation.

Older people

Good

Updated 25 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 followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • The practice maintained a list of housebound patients. The practice nurse offered home visits for these patients to provide disease monitoring and immunisations.

  • In conjunction with three other practices, the practice commissioned an Elderly Care Facilitator (ECF) service to support patients over 85 years through medical and social assessments. Sixty-eight assessments had been carried out covering issues such as assessment of falls, continence, benefits, cognitive impairment, frailty and mood.

Working age people (including those recently retired and students)

Good

Updated 25 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. The practice triaged all the on the day appointments but if patients were unable to receive a call at work the practice bypassed the triage system and provided a booked appointment.

  • 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 offered extended hours on a Wednesday evening until 8pm and 7.30am – 8am on Thursday mornings for working patients who could not attend during normal opening hours.

  • Patients could book appointments and request prescriptions online.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 July 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 94% of patients with a diagnosed mental health condition 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 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 A&E where they may have been experiencing poor mental health.

  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

  • Patients identified as having a memory problem were provided with a telephone call on the day of their appointment to prompt them to attend.

  • Staff had received training in dementia to enable them to become a dementia friendly service. We saw that dementia training outcomes had been established within the practice to support staff in this role.

  • The practice had jointly commissioned a dementia nurse to facilitate the needs of patients with dementia.

  • Data for the previous provider showed that 98% 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 higher than the CCG average of 87% and national average of 84%.

People whose circumstances may make them vulnerable

Good

Updated 25 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 housebound people and 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.

  • The practice had identified 146 patients as carers (4% of the practice list) and offered carers health checks to help them to stay healthy.

  • The practice offered longer appointments for patients with a learning disability.

  • 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 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.

  • Staff have received training to support patients with learning disabilities. Learning disability training outcomes had been developed by the practice to embed the training into practice.

  • Annual health reviews were offered to patients with a learning disability in their own home.

  • The practice was in the process of establishing weekly drop-in sessions within the practice from the Voluntary and Community Sector Hub Wellbeing Service to enable patients and carers to access additional advice and support.

  • The practice took account of the needs and preferences of patients with life-limiting progressive conditions. There were early and on going conversations with these patients about their end of life care as part of their wider treatment and care planning.