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Inspection Summary


Overall summary & rating

Good

Updated 1 December 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Rashmi Jain, also known as Stretton Medical Centre on 7 July 2016. The overall rating for the practice was ‘requires improvement’. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Dr Rashmi Jain on our website at www.cqc.org.uk.

At our previous inspection in July 2016 we rated the practice as ‘requires improvement’ for four of the five key questions we inspect against. The service required improvement for providing safe, effective, responsive and well-led services. The practice was therefore rated as ‘requires improvement’ overall. We issued four requirement notices to the provider relating to: the governance arrangements, staff recruitment, staff training and the management of complaints.

This inspection visit was carried out on 17 October 2017 to check that the provider had met their plan to meet the legal requirements. Overall the practice is now rated as good. Our key findings across all the areas we inspected were as follows:

  • The system for recording significant events and the actions taken in response to events had been improved.

  • Medicines and equipment was in place to deal with medical emergencies and staff had been provided with training in basic life support.

  • Improvements had been made to reduce risks to patient safety. For example some staff who acted as chaperones had undergone the appropriate checks for this and health and safety related assessments and risk management plans had been carried out. A sufficiently detailed fire risk assessment had not been carried out but this was addressed immediately following the inspection visit.

  • Infection control practices were good and there were regular checks on compliance with infection control measures.

  • Clinical staff assessed patients’ needs and delivered care in line with current evidence based guidance.

  • The practice used performance indicators to measure their performance. Data showed that the practice achieved results comparable to other practices locally and nationally for outcomes for patients.

  • Feedback from patients about the care and treatment they received from clinicians and staff in all other roles was positive. Patients said they were treated with dignity and respect and they were involved in decisions about their care and treatment.

  • Staff told us they felt well supported to meet the roles and responsibilities of their work.

  • The appointments system was sufficiently flexible to accommodate urgent appointments, same day appointments and pre-booked appointments. Patients told us they found it easy to make an appointment and there was good continuity of care.

  • Complaints had been investigated and responded to in a timely manner.

  • A range of enhanced services were provided to meet the needs of the local population.

  • The practice sought patient views about improvements that could be made to the service. This included the practice having and consulting with a patient participation group (PPG).

Areas where the provider should make improvements:

  • The arrangements for repeat prescribing for patients taking high risk medications should be kept under review.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 1 December 2017

The practice is rated as good for providing safe services. At our previous inspection on 7 July 2016, we rated the practice as requires improvement for providing safe services as the provider did not have all required systems in place to protect people against the risk of harm. The findings of this inspection were that the provider had introduced new systems in the areas where we had identified shortfalls and the practice is now rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Staff learnt from significant events and this learning was shared across the practice.

  • The practice had systems, processes and practices in place to keep people safe and safeguard them from abuse.

  • Procedures were in place to ensure appropriate standards of hygiene were maintained and to prevent the spread of infection.

  • Health and safety related checks were carried out on the premises and on equipment on a regular basis. However, fire risk assessments and management plans were not sufficiently robust. The provider took action to address this immediately following the inspection visit.

  • Appropriate pre-employment checks were carried out to ensure staff suitability.

  • Overall there were effective systems in place for the management of medicines. However, the arrangements for repeat prescribing for patients taking high risk medicines were not always clear.

  • The practice was equipped with a supply of medicines to support people in a medical emergency.

Effective

Good

Updated 1 December 2017

The practice is rated as good for providing effective services. At our previous inspection on 7 July 2016, we rated the practice as requires improvement for providing effective services as we found shortfalls in staff training. The provider had taken action to make improvements to these aspects of the service since our last inspection and the practice is now rated as good for being effective.

  • Patients’ needs were assessed and care was planned in line with best practice guidance.

  • The practice monitored its performance data and had systems in place to improve outcomes for patients. Data showed that outcomes for patients at this practice were comparable to those locally and nationally.

  • Staff worked alongside other health and social care professionals to understand and meet the range and complexity of patients’ needs.

  • Clinical audits were carried out to drive improvements in outcomes for patients.

  • Staff felt well supported and they had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment.

  • A system of appraisals was in place and all staff had undergone an up to date appraisal of their work.

Caring

Good

Updated 1 December 2017

The practice is rated as good for providing caring services.

  • Patients told us they were treated with dignity and respect and they were involved in decisions about their care and treatment. They gave us positive feedback about the caring nature of staff.

  • We saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • Data from the national patient survey showed that patients rated the practice comparable to others locally and nationally for aspects of care.

  • The practice maintained a register of patients who were carers and provided information about support for carers.

Responsive

Good

Updated 1 December 2017

The practice is rated as good for providing responsive services. At our previous inspection on 7 July 2016, we rated the practice as requires improvement for providing responsive services as the provider did not have appropriate arrangements in place for managing complaints. The provider had taken action to make the required improvements since our last inspection and the practice is now rated as good for providing responsive services.

  • The practice reviewed the needs of the local population and worked in collaboration with the NHS England Area Team, Clinical Commissioning Group (CCG) and partner agencies to secure improvements to services where these were identified and to improve outcomes for patients.

  • The appointment system was flexible and responsive to patients’ needs. Patients we spoke with said they did not find it difficult to get an appointment and that there was good continuity of care. Urgent and routine appointments were available the same day and routine appointments could also be booked in advance.

  • The practice provided extended access appointments three days per week. Patients could also access a GP at a Health and Wellbeing Centre in Warrington town centre during evenings and at weekends by pre-booked appointment.

  • The practice provided disabled access to the ground floor but restrictions with the size and layout of the building meant that one of the two consultation rooms was on the first floor and accessible only by stairs. Appointments were made to accommodate patients in line with these restrictions. The provider was also trying to secure funding to improve facilities for patients who were disabled.

  • Information about how to complain was readily available to patients. The practice responded quickly to issues raised and made improvements in response to complaints and other patient feedback.

Well-led

Good

Updated 1 December 2017

The practice is rated as good for being well-led. At our previous inspection on 7 July 2016, we rated the practice as requires improvement for providing well-led services as the provider did not appropriate systems in place for governing the service. The provider had taken action to make improvements to the governance arrangements since our last inspection and the practice is now rated as good for being well-led.

  • The provider was aware of the performance of the practice and they used available data to monitor outcomes for patients and provide clinical care and treatment.

  • Staff felt supported by the GP provider and practice manager. The provider was aware of and complied with the requirements of the duty of candour. The provider encouraged a culture of openness and honesty.

  • The practice had a range of policies and standard operating procedures to govern activity.

  • The practice sought feedback from staff and patients. This included the practice having a patient participation group (PPG).

  • The provider worked with partner agencies to learn, develop and improvement the practice and outcomes for patients.

  • The challenges and future developments of the practice had been considered.

Checks on specific services

People with long term conditions

Good

Updated 1 December 2017

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

  • The practice held information about the prevalence of specific long term conditions within its patient population. This included conditions such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. The information was used to target service provision, for example to ensure patients who required immunisations received these.

  • Regular, structured health reviews were carried out for patients with long term conditions.

  • Patients were provided with advice and guidance about prevention and management of their health and were signposted to support services.

  • Data from 2014 to 2015 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions.

  • Longer appointments and home visits were available for patients with long term conditions when these were required.

  • Patients at risk of developing a long term condition were referred to support services such as smoking cessation.

Families, children and young people

Good

Updated 1 December 2017

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

  • There were systems in place to identify and follow up children living in disadvantaged circumstances and those who were at risk, for example, children and young people who had a high number of A&E attendances.

  • Staff had been provided with training in safeguarding.

  • The GP provider was the designated lead for child protection.

  • Staff had ready access to safeguarding policies and procedures.

  • Child surveillance clinics were provided for 6-8 week olds and immunisation rates were comparable to the national average for all standard childhood immunisations. Opportunistic immunisations were given to encourage uptake.

  • Babies and young children were offered an appointment as priority and appointments were available outside of school hours.

  • Family planning and contraceptive services were provided.

Older people

Good

Updated 1 December 2017

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

  • The practice offered proactive, personalised care and treatment to meet the needs of the older people in its population. The practice kept up to date registers of patients with a range of health conditions (including conditions common in older people) and used this information to plan reviews of health care and to offer services such as vaccinations for flu. 

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were comparable to local and national averages.

  • The GP carried out regular visits to local care homes to assess and review patients’ needs.

  • Home visits and urgent appointments were provided for patients with enhanced needs.

  • The practice used the ‘Gold Standard Framework’ (this is a systematic evidence based approach to improving the support and palliative care of patients nearing the end of their life) to ensure patients received appropriate care.

Working age people (including those recently retired and students)

Good

Updated 1 December 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.

  • Early morning appointments were available three days per week. The practice was part of a cluster of practices whose patients could access appointments at a local Health and Wellbeing Centre at evenings and weekends, through a pre-booked appointment system.

  • Telephone consultations were provided and patients therefore did not always have to attend the practice in person.

  • The practice provided a full range of health promotion and screening that reflected the needs of this age group. For example, patients aged 40-74 were offered health checks.

  • The practice was proactive in offering online services including the booking of appointments and requests for repeat prescriptions. Electronic prescribing was also provided.

People experiencing poor mental health (including people with dementia)

Good

Updated 1 December 2017

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

  • The practice held a register of patients experiencing poor mental health and these patients were offered an annual review of their physical and mental health.

  • Data about how people with mental health needs were supported showed that outcomes for patients using this practice were comparable to local and national averages.

  • The practice referred patients to appropriate services such as psychiatry and counselling services.

  • The practice hosted a psychotherapy service and patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

  • The practice provided shared care with a local psychiatric service.

People whose circumstances may make them vulnerable

Good

Updated 1 December 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 in order to provide the services patients required. For example, a register of people who had a learning disability was maintained to ensure patients were provided with an annual health check and to ensure longer appointments were provided for patients who required these.

  • The practice was accessible to people who required disabled access. However, facilities such as an accessible toilet or a hearing loop system (used to support patients who wear a hearing aid) were not available.

  • The practice provided two consultation rooms one of which was on the first floor. Staff told us they used the appointments system to accommodate patient’s access needs but the limited availability of ground floor facilities was restrictive.

  • Information and advice was available about how patients could access a range of support groups and voluntary organisations.

  • The practice hosted a community dietician service and a psychotherapy service.

  • The practice also hosted a weekly Social Services session involving a social worker available to advise and support patients with their social care needs.