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Inspection Summary


Overall summary & rating

Good

Updated 27 March 2017

Letter from the Chief Inspector of General Practice

On 3 March 2016, we carried out an announced comprehensive inspection of this practice, which at that time was provided by Shiremoor Medical Group. We rated the practice as inadequate in all five domains of safe, effective, caring,responsive and well-led and the practice was placed in special measures.

A new provider, Bridge Medical, was put in place to provide Regulated Activities from 1 April 2016. After the comprehensive inspection, the new provider wrote to us to say what they would do to address the issues raised at the inspection. The new provider has changed the name of the practice to Bridge Medical. We undertook this comprehensive inspection on 11 October 2016 to check that the new provider had followed their plan. You can read the report from our last comprehensive inspection by selecting the ‘all reports’link for Shiremoor Medical Group on our website at www.cqc.org.uk.

Overall, the practice is rated as good.

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

  • The new provider completed the process Complete the process for registering as a provider of regulated activities and for appointing a registered manager for the practice in line with CQC guidance in January 2017.

  • The new provider had taken effective steps to make improvements following the last inspection in March 2016; some of the new arrangements were at an early stage and work was still in progress in many areas.They had developed a clear vision, strategy and plan to deliver high quality safe care and promote good outcomes for patients.
  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care inline with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Patients said they were treated with compassion,dignity and respect and they were involved in their care and decisions about their treatment. They commented positively on the changes to the practice since the new provider had taken over and on the excellent care they had received from several of the new GPs.
  • Information about services and how to complain was available and easy to understand.
  • Some patients said they found it difficult to make routine appointments with a GP. 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 new management structure and clinical team. The practice proactively sought feedback from staff and patients, which it acted on. Staff told us they had been engaged by the practice to support the changes that had been made. Staff were consistent in their praise of the level of support that was now available from management and clinical staff, they felt that they could raise issues and that there was a no blame culture at the practice.
  • The new provider was aware of and complied with the requirements of the duty of candour regulation.
  • The new provider was undertaking work to improve the care and support offered to carers, for example, a carer’s policy had been introduced and a carers champion had recently been appointed

The area where the provider should make improvements are:

  • Review the management of complaints at the practice to ensure verbal complaints are taken account of.

I am taking Shiremoor Medical Group out of special measures. This recognises the significant improvements made to the quality of care provided at this practice by the new provider.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 27 March 2017

The practice is rated as good for providing safe services.

The new provider

practice had taken action to address the concerns raised during our previous inspection in March 2016. They had implemented systems that would support them to demonstrate that they provided safe services; this was a clear priority of the new provider.This included improved arrangements for:

  • The management, and learning from, significant events and for keeping patients safe and safeguarded from abuse.
  • The management of safety alerts from the Medical and Healthcare products Regulatory Authority (MHRA).
  • Infection control, we also saw that the practice was clean and hygienic.
  • Ensuring sufficient staffing levels were in place.

We also found:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • Arrangements were in place to ensure that when there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes and prevent the same thing happening again.

  • Disclosure and Barring Service (DBS) checks or risk assessments had been completed for all staff that required them.

Effective

Good

Updated 27 March 2017

The practice is rated as good for providing effective services.

The new provider had taken action to address the concerns raised during our previous inspection in March 2016. They had taken steps to ensure they provided effective services; this was a priority of the new provider. This included improved arrangements to:

  • Monitor the outcomes of patients using the Quality and Outcomes Framework (QOF) data.

  • Work collaboratively with other professionals, for example,regular palliative care and safeguarding meetings were used by the practice to understand the range and complexity of patient needs.

We also found:

  • Quality improvement work was taking place. Clinical audit was driving improvement in performance to improve patient outcomes.
  • Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • The practice had started a schedule of regular supervision meetings with staff, some of these had been completed and the rest of these had been planned. Staff told us that the practice was supportive of training and development. We saw that mandatory training had been completed or planned by the practice.

Caring

Good

Updated 27 March 2017

The practice is rated as good for providing caring services.

The new provider had taken action to address the concerns raised during our previous inspection in March 2016. They had implemented systems that would support them to demonstrate that they provided caring services. This included improved arrangements to:

  • Provide effective and consistent clinical care. Feedback from patients was consistently positive about the care they received from the GPs now in post.
  • Provide bereavement support. We saw evidence that palliative care meetings took place regularly and that a GP palliative care lead had been put in place.

We also found:

  • Results from the National GP Patient Survey, published in July 2016, showed that the practice was still below average for consultations with doctors. However, this survey had been completed when the previous provider was in place.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Information for patients about the services offered by the practice was available. For example, they provided this information on the practice’s website and in the patient leaflet and waiting areas.
  • The practice had links to local and national support organisations and referred patients when appropriate.

Responsive

Good

Updated 27 March 2017

The practice is rated as good for providing responsive services.

The new provider had taken action to address the concerns raised during our previous inspection in March 2016. They had implemented systems that would support them to demonstrate that they provided responsive services. This included improved arrangements to:

  • Provide continuity of care. The partners aimed to work regular days each week to support continuity of care and arrangements had been made to ensure that doctors could review test results on days when they were working at other locations. The practice had reduced the use of locum GPs.

  • Record and manage complaints received. All written complaints were now managed in line with national guidance; however, the practice was not recording verbal complaints.

We also found:

  • Extended hours appointments were currently not available. The practice hoped to be able to provide this service by the end of the year.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
  • Although some patients said they found it difficult to make routine appointments with a GP 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.

Well-led

Good

Updated 27 March 2017

The practice is rated as good for being well-led.

The new provider had taken clear actions to address the concerns raised during our previous inspection in March 2016. They had implemented systems that would support them to demonstrate that they provided well-led services. This included improved arrangements to:

  • Lead and develop the practice. A clear vision and strategy had been developed. Staff we spoke to were aware of the vision and strategy.
  • Govern the practice. We saw that partners at the practice had leads in key areas and work had been undertaken to address all areas of concern raised at the last inspection.
  • Manage and implement policies and procedures, those we looked at had recently been reviewed.
  • Lead the practice. There was now a clear leadership structure and staff felt supported by management.

We could see that the new provider, Bridge Medical, had made many improvements. However, due to the number of issues raised at the last inspection and the risks this created for the new provider more time was required for the changes made to become fully embedded within the practice.

We also found:

  • Quality improvement work was taking place. Clinical audit was driving improvement in performance to improve patient outcomes.
  • The new provider was aware of and complied with the requirements of the duty of candour regulation. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.
Checks on specific services

Older people

Good

Updated 27 March 2017

The practice is rated as good for the care of older people.

  • The practice offered proactive, personalised care to meet the needs of the older people in their population. All patients over the age of 75 had a named GP.
  • The practice had introduced a system to ensure that all patients over the age of 75 were offered an annual health check.
  • The practice was responsive to the needs of older people; they offered home visits and urgent appointments for those with enhanced needs.
  • Nationally reported data showed that outcomes for patients with conditions commonly found in older people were generally in line with local and national averages. For example, the practice had achieved 100% of the Quality and Outcomes Framework (QOF) points available for providing the recommended care and treatment for patients with heart failure. This was 0.1% above the local clinical commissioning group (CCG) average and 2.1% above the national average.
  • The practice maintained a palliative care register and offered immunisations for shingles and pneumonia to older people.

People with long term conditions

Good

Updated 27 March 2017

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

  • The nurses and partners had lead roles in chronic disease management.
  • Patients at risk of hospital admission were identified as a priority and supported appropriately by the practice. Comprehensive care plans were in place and regularly reviewed.
  • Nationally reported data showed that outcomes for patients with most conditions commonly found in this population group were generally in line with local and national averages. For example, the practice had achieved 97.7% of the QOF points available for providing the recommended care and treatment for patients with peripheral arterial disease. This was 0.6% below the local CCG average and 1.1% above the national average.
  • The new provider had initiated work to improve patient outcomes for patients with long-term conditions.
  • Longer appointments and home visits were available when needed.
  • The new provider had undertaken work to ensure that all patients with a long-term condition were offered 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.

Families, children and young people

Good

Updated 27 March 2017

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

  • There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were now regularly reviewed at practice multidisciplinary meetings involving child care  professionals such as health visitors. A children’s safeguarding lead was now in place.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were arrangements for new babies to receive the immunisations they needed. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 95.5% to 100% (CCG average 73.3% to 95.1%) and for five year olds ranged from 91.4% to 100% (CCG average 81.4% to 95.1%).
  • Urgent appointments for children were available on the same day.
  • Pregnant women were able to access an antenatal clinic provided by healthcare staff attached to the practice.
  • Nationally reported data showed that outcomes for patients with asthma were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with asthma.This was 2.4% above the local CCG average and 2.6% above the national average.
  • The practice provided contraceptive advice.

Working age people (including those recently retired and students)

Good

Updated 27 March 2017

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • Telephone appointments were available.
  • Patients could order repeat prescriptions and book routine healthcare appointments online.
  • A text message service informed patients of the details of their appointment if requested.
  • Extended hours appointments are currently not available.
  • The practice offered a full range of health promotion and screening which reflected the needs for this age group.
  • The practice’s uptake for cervical screening was 93.4%, which was above to the CCG average of 83% and the national average of 81.8%. The exception rate (when patients are excluded form figures because, for example, they do not attend) was 18.7%, compared to the local average of 4.7% and the national average of 6.3%. The practice was working to reduce the number of excluded patients.
  • Additional services such as new patient health checks, travel vaccinations and minor surgery were provided.
  • The practice website was being developed to provide a good range of health promotion advice and information.

People whose circumstances may make them vulnerable

Good

Updated 27 March 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. This included a register of patients with a learning disability; the practice had reviewed this register to ensure it was up to date. Patients with a learning disability had been invited to the practice for an annual health check. Twenty-one patients were on this register; to date 52% had received an annual review.
  • The practice had created a register of high-risk patients that included, for example, patients who required palliative care,dementia or who were frail. Seventy-eight patients were initially identified. Care plans and medication reviews were put in place and monthly meetings held to discuss their care . High-risk patients who met additional criteria were referred by the practice to an external support agency that provided a wide range of support aimed to reduce unplanned hospital admissions.
  • Nationally reported data showed that outcomes for patients with a learning disability were good. The practice had achieved 100% of the QOF points available for providing there commended care and treatment for patients with a learning disability. This was the same as the local CCG average and 0.2% above the national average.

  • The practice offered longer appointments for patients with a learning disability if required.
  • The practice regularly worked with multi-disciplinary teams(MDT) in the case management of vulnerable people.
  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff 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.
  • Good arrangements were in place to support patients who were carers. A carer’s policy had been introduced and a carers champion had recently been appointed.

People experiencing poor mental health (including people with dementia)

Good

Updated 27 March 2017

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

  • The practice had identified 0.5% of their patient list as having enduring mental health conditions and had included these patients on a register to enable them to plan and deliver relevant services. Twenty-seven patients were on this register. Since April 2016 41% of these patients had received an annual review.
  • Nationally reported data showed that outcomes for patients with mental health conditions were above average. The practice had achieved 100% of the QOF points available for providing the recommended care and treatment for patients with mental health conditions. This was 4.8% above the local CCG average and 7.2% above the national average.
  • Nationally reported data showed that outcomes for patients with dementia were in line with the average. The practice had achieved 96.7% of the QOF points available for providing the recommended care and treatment for patients with dementia. This was 0.1% above the local CCG average and 2.2% above the national average. 75% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months, which was below the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and the practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice told us they planned to implement a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.