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Dr Manmohan Singh Good Also known as George Eliot Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 21 April 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Manmohan Singh (also known as George Eliot Medical Centre) on 27 September 2016. Overall the practice is rated as good.

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

  • The practice had an appropriate system for reporting and recording significant events. We saw evidence that lessons were learned from incidents, and that learning was discussed to ensure improvements were implemented.
  • A number of risk assessments and processes ensured that patients were kept safe and safeguarded from abuse.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were lower than CCG and national averages in the uptake of cervical, breast and bowel cancer screening. Following the inspection the practice provided evidence of improvements in these areas.
  • The outcomes of patients’ care and treatment were not always monitored regularly.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Training was monitored and updated consistently.
  • The practices performance in patient satisfaction was mixed, with results slightly lower than average for GP consultations. The patients we interviewed and comment cards we reviewed told us they patients felt included in making decisions about their care and the treatment they received. They also said GPs were good at listening to them and gave them enough time and information to reach decisions.
  • The practice was responsive to the needs of the local population. GP and non-clinical staff at the practice spoke a number of different languages to accommodate the diverse patient population, including Gujurati, Hindi, Punjabi and Urdu. External translation services were also available and patient literature was available in a variety of languages.
  • Patients were highly satisfied with how they could access appointments at the practice.
  • Information about services and how to complain was available and easy to understand.
  • The practice had modern facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice had a proactive approach to seeking feedback from staff and patients, and we saw evidence that feedback were acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Continue to encourage patients to engage with cervical, breast and bowel cancer screening programmes.
  • Improve the system for clinical audit to monitor outcomes and improvements made.
  • Create an action plan to improve GP Patient Survey data regarding consultations with GPs.
  • Keep the recently implemented systems for tracking of prescription stationery and monitoring uncollected prescriptions under review to ensure they are effective.
  • Maintain a record of verbal complaints received so they can be reviewed for themes, patterns or trends.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 21 April 2017

The practice is rated as good for providing safe services.

  • The practice had an appropriate system for reporting and recording significant events.
  • We saw evidence that lessons were learned from incidents, and that learning was discussed to ensure improvements were implemented.
  • A number of risk assessments and processes ensured that patients were kept safe and safeguarded from abuse. Pre-employment checks had been made to help ensure staff were safe to work with the patients.
  • Checks were in place to make sure the premises and equipment used were safe and appropriate standards of cleanliness and hygiene were maintained.
  • There were arrangements to respond to major incidents and emergencies and staff knew what action they should take in urgent situations.
  • The practice also had a system to monitor prescriptions that had not been collected by patients but this was not checked frequently. Although prescription stationery was stored securely before and during use, serial numbers were not recorded to monitor their use. Immediately following the inspection the practice provided information that they had implemented systems to monitor these areas effectively.

Effective

Good

Updated 21 April 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were in line with CCG and national averages, except for in cervical, breast and bowel cancer screening where they were lower. The practice provided information following the inspection which showed increased patient uptake in these areas.
  • Clinical audits were carried out regularly but these were not repeated to confirm that that improvements made had a positive impact.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Training was monitored and updated consistently.
  • Staff communicated well as a team and there was evidence of appraisal for all staff. Staff we spoke with expressed confidence in raising concerns with the management team.
  • There was a commitment to collaborating with healthcare professionals from external services to understand and meet patients’ needs.
  • The service was aware of its obligations regarding consent and confidentiality.

Caring

Good

Updated 21 April 2017

The practice is rated as good for providing caring services.

  • Results from the national GP Patient Survey published in July 2016 showed that the practices performance in patient satisfaction was mixed, with results slightly lower than average in GP consultations.
  • We observed staff to be kind and helpful to patients and to treat them with dignity and respect.
  • The patients we interviewed and comment cards we reviewed told us they patients felt included in making decisions about their care and the treatment they received. They also said GPs were good at listening to them and gave them enough time and information to reach decisions.
  • Information for patients about the services available was easy to understand and accessible.
  • Staff told us that if families had suffered bereavement, the GP contacted them by telephone and offered to make a home visit. The GP offered to refer patients for bereavement counselling and provided information that may assist them.

Responsive

Good

Updated 21 April 2017

The practice is rated as good for providing responsive services.

  • The GP and non-clinical staff at the practice spoke a number of different languages to accommodate the diverse patient population, including Gujurati, Hindi, Punjabi and Urdu. External translation services were also available and patient literature was available in a variety of languages.
  • The GP was an active member of the community and offered health promotions at local temples and churches to engage with patients.
  • Results from the national GP patient survey showed that patients’ satisfaction with how they could access care and treatment was in line with or in some areas significantly higher than both local and national averages.
  • Patients we spoke with during the inspection told us they were able to get appointments when they needed them.
  • Information was available to help patients understand the complaints system. There was a complaints policy leaflet on display on the reception desk. The practice managed verbal complaints and discussed these at team meetings, but they were not being recorded and reviewed to identify common themes.

Well-led

Good

Updated 21 April 2017

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

  • The practice had a mission statement and a set of values. Staff we spoke with were aware of the mission statement and worked in a way that supported it.
  • Staff were clear of their roles and responsibilities and knew who clinical and non-clinical leads were.

  • The practice held monthly whole practice meetings. The practice culture was open and friendly, and staff were encouraged to raise issues and make suggestions.
  • The practice was aware of the requirements of the duty of candour and systems were in place to ensure compliance with this.

  • The practice had a proactive approach to seeking feedback from staff and patients, and we saw evidence that feedback were acted on.
Checks on specific services

People with long term conditions

Good

Updated 21 April 2017

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

  • Longer appointments and home visits were available to patients with long term conditions when needed.
  • Performance for diabetes related indicators was similar to the national average performance. For example, 95% of patients had a flu immunization in the previous 12 months, in line with the CCG average of 93% and the national average of 95%. Exception reporting was 4%, lower than the CCG average of 18% and national average of 20%. The practice offered diabetic patients access to an in-house dietician to help them manage their condition.
  • Performance for other long term conditions was within average range. The percentage of patients with COPD who had received the flu immunization in the preceding 12 months was 95%, comparable to the CCG figure of 96% and the national 97%. Exception reporting for this indicator was 17%, compared with the CCG and national averages of 18%. The percentage of patients with hypertension in whom the last blood pressure reading measured within an acceptable range in the preceding 12 months was 80%, in line with the CCG and national averages of 83%. Exception reporting for this indicator was 5%, compared with the CCG average of 3% and the national average of 4%.
  • Patients received a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 21 April 2017

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

  • Same day appointments were available for children. Appointments were also available outside of school hours and the premises were suitable for children and babies.
  • Childhood immunisation rates for the vaccinations given were mixed. For example, for the vaccinations given to under two year olds the practice achieved an overall score of 9.2 out of 10, compared with the national average score of 9.1. The mumps, measles and rubella vaccinations given to under five year olds ranged from rates of 72% to 100%, compared with the national average rates which were between 88% and 94%
  • The practice worked with district nurses, midwives and health visitors to coordinate care. The GPs was the practice’s safeguarding lead who engaged with local health visitors. All staff were trained to the appropriate child safeguarding level.
  • Clinical staff demonstrated their understanding of Gillick competence and Fraser guidelines, and why these needed to be considered when providing care and treatment to young patients under 16. The Gillick test is used to help assess whether a child has the maturity to make their own decisions and to understand the implications of those decisions. Fraser guidelines related specifically to contraception, sexual health advice and treatment.

Older people

Good

Updated 21 April 2017

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

  • Care was tailored to meet the needs of the older people in the practice population.
  • Home visits were available for older patients and patients who had clinical needs which resulted in difficulty attending the practice. This included visits to administer the flu vaccination to patients who were unable to visit the practice independently.
  • Same day appointments were available for older people whose health required an urgent consultation.
  • Appointments were pre-bookable in advance with no limit to the number of weeks ahead these were available.
  • The practice had completed 95% of its NHS over 75s health checks during 2014/2015, and continued to perform at a high level for the current year.

Working age people (including those recently retired and students)

Good

Updated 21 April 2017

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

  • Patients could access online appointment booking services.
  • Appointments were offered at the beginning and end of the day to accommodate those who could not attend during working hours.
  • Telephone consultations were available for patients who did not feel they required a physical consultation or who had difficulty in attending the practice during opening hours.
  • A full range of health promotion and screening was available, including NHS health checks for those aged 40 to 74.

People experiencing poor mental health (including people with dementia)

Good

Updated 21 April 2017

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

  • 100% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was significantly higher than the CCG average of 81% and the national average of 84%. Exception reporting for this indicator was 0%, compared with the CCG average of 6% and the national average of 7%.
  • 88% of patients experiencing poor mental health had their alcohol consumption recorded in the previous year, which was similar to the CCG and national averages of 89%. The practice’s exception reporting was 0%, lower than the CCG average of 8% and the national average of 10%.
  • Patients experiencing poor mental health were given information about how to access support groups and voluntary organisations. For example, Improving Access to Psychological Therapies counsellors held weekly clinics at the practice.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice maintained a mental health register and performed physical and mental health annual reviews for these patients. During the previous four years the practice had completed 100% of annual reviews for mental health patients.
  • The GP had completed a number of mental health courses to improve patient care. These subjects included the Mental Capacity Act, Deprivation of Liberties Safeguards, and identification of suicidal patients.

People whose circumstances may make them vulnerable

Good

Updated 21 April 2017

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • Longer appointments were available for patients who needed them, such as those with a learning disability. Patients with a learning disability were also offered appointments at less busy times of the day if large numbers of people resulted in anxiety.
  • Appointments could be arranged on the same day vulnerable patients.
  • The practice had no travellers or homeless people on their patient list at the time of our inspection but explained they would register and accept people from these groups as temporary or permanent patients as needed.
  • The premises provided disabled access and a hearing loop. The GP and non-clinical staff at the practice spoke a number of different languages to accommodate the diverse patient population, including Gujurati, Hindi, Punjabi and Urdu. External translation services were also available and patient literature was available in a variety of languages.
  • The practice held a registers of a number of circumstances that may make patients vulnerable, for instance for carers, children on the child protection register, and patients who were housebound. The registers were used to manage and offer support to patients.
  • Staff had received safeguarding training and knew how to recognise signs of abuse in children and adults.