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Archived: Malling Health @ Parsonage Street Good

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Inspection Summary


Overall summary & rating

Good

Updated 17 December 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Malling Health @ Parsonage Street on 19 June 2015. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Information about safety was recorded, monitored, appropriately reviewed. However follow up of actions was not always clearly reported.
  • Risks to patients were assessed and generally well managed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.

  • Patients said they were treated with dignity and respect and they were involved in their care and decisions about their treatment. However, published data from the latest GP national patient survey showed scores that were lower than other practices in the locality and nationally.
  • Information about services and how to complain was available and easy to understand.
  • There was mixed feedback from patients about access to appointments and satisfaction with consultations. Results from the national GP patient survey were below local and national averages for many indicators. Our feedback from patients during the inspection was more positive.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure. There were opportunities for staff to provide feedback and staff felt listened to and supported by management.

We saw one area of outstanding practice:

  • The practice had worked with local businesses and the Big Issue to provide support to some of the most vulnerable people on public holidays such as Christmas Day, providing food and somewhere for them to go. Approximately 100 people had turned up to the last event.

However there were areas of practice where the provider needs to make improvements.

Importantly the provider should:

  • Improve record keeping for recording follow up of actions from significant events and complaints.
  • Ensure audits complete their full audit cycle in order to demonstrate improvements made to practice.
  • Ensure systems are in place for updating patient records following multi-disciplinary team meetings.
  • Review patient survey information to identify how patient satisfaction could be improved.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 17 December 2015

The practice is rated as good for providing safe services. Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement although records seen did not always show that actions had been followed up. Risks to patients were assessed and generally well managed although we found some areas for improvement with the COSHH risk assessment and with recruitment records.

Effective

Good

Updated 17 December 2015

The practice is rated as good for providing effective services. Data showed patient outcomes were at or above average for the locality. Staff referred to and used guidance from the National Institute for Health and Care Excellence. Although audits were used to support improvement these were not always repeated to demonstrate improvements had been maintained. Patients’ needs were assessed as appropriate and care was planned. Staff understood current legislation when assessing capacity and promoting good health. Staff had received training appropriate to their roles and were supported to meet training needs to enable them to do their job. There was evidence that staff received appraisals. Staff worked with multidisciplinary teams to meet the needs of patients who were most vulnerable.

Caring

Good

Updated 17 December 2015

The practice is rated as good for providing caring services. Although data showed that patients rated the practice lower than others for several aspects of care feedback from patients during the inspection was mostly positive. Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment. Information for patients about the services available was easy to understand and accessible. We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 17 December 2015

The practice is rated as good for providing responsive services. It was aware of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services. The practice offered a walk in centre service alongside the practice for registered patients. Most patients we received feedback from were happy with the appointment system however this was in contrast with the latest GP National Patient Survey in which many indicators relating to access were lower than the CCG 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 easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff but reports did not always clearly show actions to mitigate further re-occurrence.

Well-led

Good

Updated 17 December 2015

The practice is rated as good for being well-led. It had a clear vision and strategy. Staff were clear about the vision and their responsibilities in relation to this. There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. There were systems in place to monitor and improve quality and identify risk. The practice sought feedback from staff and patients, which it acted on. Staff felt valued and attended regular staff meetings to share information.

Checks on specific services

People with long term conditions

Good

Updated 17 December 2015

The practice is rated as good for the care of people with long-term conditions. Nursing staff had lead roles in chronic disease management and received appropriate training to support these patients. Patients with long term conditions received at the minimum annual reviews and had access to a named GP. The practice held multi-disciplinary team meetings with other health professionals to discuss care needs of those with the most complex needs. Care plans were also in place to help minimise the risk of hospital admission. Home visits were available for those whose health needs prevented them from attending the practice.

Families, children and young people

Good

Updated 17 December 2015

The practice is rated as good for the care of families, children and young people. The practice had a higher proportion of younger patients registered with them than the national average. There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk. Childhood immunisation rates were comparable with other practices locally. Those that did not attend for immunisations were followed up and the practice worked closely with the health visitors. Appointments were available outside of school hours and urgent appointments for children under five were offered within four hours. The premises were accessible for pushchairs and baby changing facilities were available. The practice offered six to eight week baby health checks.

Older people

Good

Updated 17 December 2015

The practice is rated as good for the care of older people. The practice had a lower proportion of older patients registered with them than the national average. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. Patients over 75 had an allocated named GP. The uptake of seasonal flu vaccinations for this age group was comparable to other practices. The practice had a range of enhanced services, for example, in dementia and end of life care to support the needs of the older people in its population. Care plans were in place for those with increased risk of hospital admission and multidisciplinary team meetings regularly took place to discuss those with enhance needs including end of life care needs. Home visits were available for those whose health needs made it difficult for them to attend the practice.

Working age people (including those recently retired and students)

Good

Updated 17 December 2015

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice had a higher proportion of working age patients registered with them than the national average The needs of the working age population, those recently retired and students were recognised. The practice provided accessible and flexible services for those with working commitments who were unable to attend during the day. This included on-line services for appointments and prescriptions, the availability of telephone appointments and a walk in service. Text messaging was used to remind patients of their appointments. The practice offered a range of health promotion and screening that reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 17 December 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Nationally reported data showed that outcomes for patients experiencing poor mental health were better than those for other practices locally and nationally. Those on the mental health register received annual reviews. The practice regularly worked with multi-disciplinary teams in the case management of this population group. The practice shared a building with the mental health team. The practice participated in the enhanced service to support the early diagnosis and treatment of patients with dementia.

People whose circumstances may make them vulnerable

Good

Updated 17 December 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held registers of patients living in vulnerable circumstances including those with a learning disability, poor mental health and palliative care needs and had carried out an annual health check for the majority of their vulnerable patients. The practice had signed up for the learning disability enhanced service and had a trained member of staff in this area. It offered longer appointments for people who needed them and walk in appointments. The practice had worked with local organisations to provide a drop in service during public holidays.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. 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.