You are here

Dr Linda Kandola Good Also known as The Gamston Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 13 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Linda Kandola also known as The Gamston Medical Centre on 15 March 2016. Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events. Learning outcomes were shared with staff.
  • Risks to patients were assessed and well managed. Health and safety precautions had been taken which included checking that equipment was fully working and safe to use and infection prevention control measures were in place.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Clinical audit drove quality improvement. 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. Patient feedback which included the National GP Patient Survey rated the care provided highly.
  • Information about services and how to complain was available and easy to understand. All staff we spoke with knew the procedure in place for addressing patient complaints.
  • Patients said they found it easy to make an appointment, although not always with a named GP. The practice was seeking to recruit an additional salaried GP to respond to patient demand. 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 management. The practice proactively sought feedback from staff and patients, which it acted on.

The areas where the provider should make improvement are:

  • Ensure that evidence of staff identification is obtained and held on personnel files during recruitment.

  • Review their process and recording procedure for exception reporting, in particular areas of QOF achievement, such as mental health and heart failure indicators.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 May 2016

The practice is rated as good for providing safe services.

  • There was an effective and robust system in place for reporting and recording significant events. All staff knew how to report incidents and a number of documents we were provided supported this assurance process.

  • Lessons were shared to make sure action was taken to improve safety in the practice. Detailed records included analysis of the events and risk assessment to reduce potential reoccurrence. Learning outcomes were shared in practice meetings.

  • 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 to prevent the same thing happening again.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. This included infection control procedures, management of medicines, staff recruitment procedures and appropriate training of staff in safeguarding.

  • Risks to patients were assessed and generally well managed. This included health and safety, ensuring sufficient staff in place to meet patient needs and suitable emergency procedures if a patient presented with an urgent medical condition. The practice should however ensure it obtains evidence of staff identification during any recruitment process.

Effective

Good

Updated 13 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average for the locality and comparable with the national average. The practice had achieved 96% of available QOF points in 2014/15. The practice’s overall exception rate reporting was 5.8% which was below the CCG average of 8.3% and national average of 9.2%.

  • Exception rate reporting was however significantly above CCG and national averages in relation to some areas of practice. The practice exception rate reporting was 10.3% above CCG average and 11.6% above national average for one mental health indicator and 11.5% above CCG average and 11.4% above national average for one heart failure indicator. The practice told us they had not removed patients from some of their registers even if they had a historic diagnosis of a particular medical condition recorded and no current related health problems. The practice told us that they would look into whether these patients should remain on the registers and review their exception rate recording and rationales.

  • Staff assessed needs and delivered care in line with current evidence based guidance such as National Institute Clinical Excellence (NICE).

  • Clinical audits demonstrated quality improvement including improved patient outcomes. For example, an audit in hysterectomy/cytology identified areas of improvement regarding practice read coding.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. Staff we spoke with told us they felt supported by management and were able to maintain their continuing professional development.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked regularly with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 13 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice higher than others for several aspects of care. This included 96% of patients who said the last nurse they spoke to was good at treating them with care and concern compared to the CCG average of 92% and national average of 91%. Data also showed that 92% of patients considered receptionists at the practice helpful compared to the CCG average of 90% and national average of 87%.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • A variety of information for patients about the services available was easy to understand and accessible. This included information for carers of all ages.

  • The practice had nominated a carers champion whose role included the sharing of good practice with other local practices within the CCG.

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

Responsive

Good

Updated 13 May 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. The practice hosted a hospital service in its premises for all local Rushcliffe residents. This included a community heart failure service (Echo), diabetic retinopathy service and a diabetic hospital specialist nurse clinic.

  • Patients said they found it easy to make an appointment, although not always with a GP they preferred. There was continuity of care, with urgent appointments available the same day. This was reflected in feedback from the national GP patient survey. For example:

  • 95% patients said they could easily get through to the surgery by phone which was above CCG average of 81% and national average of 73%.

  • 39% patients said they usually get to see or speak to the GP they prefer compared to the CCG average of 61% and national average of 59%. The practice told us they were seeking to recruit a new GP in response to patient feedback. They anticipated this would create more available appointments with patients’ preferred GPs.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

    This included disabled facilities, a hearing loop and translation services.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 13 May 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff we spoke with 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 was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • 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. Annual review took place to ensure any corrective measures implemented from incidents which occurred had been effective.

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and had engaged with patients to obtain feedback and organise local events.

  • There was a strong focus on continuous learning and improvement at all levels. This was reflected in staff development, audits undertaken and the practice plans for the future.

Checks on specific services

People with long term conditions

Good

Updated 13 May 2016

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

  • Nursing staff had lead roles in chronic disease management with support from practice GPs.

  • Patients at risk of hospital admission were identified as a priority and appropriate action was taken to reduce the likelihood of attendance. The practice had identified 113 people on its register for people who were at risk of hospital admission and all of these patients had a care plan in place.

  • National data showed the practice was performing broadly in line with the local CCG average for its achievement within eleven diabetes indicators.The practice achieved91% of the available QOF points compared with the CCG average of 95%. Achievement was however above the national average of 89%.

  • 91% of patients diagnosed with asthma, on the register, had an asthma review in the last twelve months. This was above the CCG average of 79% and national average of 75%.

  • The practice offered near-patient testing for anticoagulation. This meant that immediate test results were available for these patients who were subject to routine monitoring.

  • The practice had 615 patients with chronic diseases registered. All these patients were offered a structured annual review to check their health and medicines needs were being met.

  • Practice supplied data showed that 510 patients had received these checks although this data had not been verified and published. 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.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 13 May 2016

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 who were at risk, for example, children and young people who had a high number of A&E attendances.

  • Immunisation rates for all standard childhood immunisations ranged from 91% to 99%. This was comparable to CCG averages which ranged from 94% to 99%.

  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and our discussions with staff supported this.

  • The practice promoted providing confidential teenage health advice and information was displayed in the practice and on their website for young people to see.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • We saw that effective collaborative working took place between doctors in the practice, midwives and health visitors. This was evidenced through our discussions held with a health visitor during our inspection.

Older people

Good

Updated 13 May 2016

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 its population. All older patients had a named GP. Frequent visits were made by the practice GPs to their care home patients in and outside of working hours. A care home manager we spoke with praised the practice for their responsiveness and hands on approach.

  • Care plans had been implemented for those patients identified as close to the end of life. The practice held regular multidisciplinary meetings where all patients who were vulnerable and requiring intervention were discussed with input from other care teams into their holistic care.

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Data supplied by the practice showed that flu vaccination rates in 2015/16 for the over 65s were 82% (CCG average 78%) Saturday flu clinics were offered to patients to encourage uptake.

Working age people (including those recently retired and students)

Good

Updated 13 May 2016

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

  • The practice offered appointments on weekdays up until 6pm which enabled some flexibility for working age patients, students and those recently retired to attend. The practice told us they had also increased telephone consultations to accommodate these patients.
  • The practice told us that staff contacted these patients after 6.30pm with test results.

  • 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.

  • 94% of women aged over 25 but under 65 had received a cervical screening test in the previous 5 years. The practice was performing above the CCG average of 88% and national average of 82%.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 May 2016

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

  • 100% of patients with a mental health condition had a documented care plan in place in the previous 12 months. This was above the CCG average of 93% and above the national average of 88%. Exception reporting was 10.3% above CCG average however and 11.6% above national average.

  • 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG average of 88% and national average of 84%. Exception reporting was in line with the CCG average and national average.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. We saw a variety of information displayed in the practice, for example, Alzheimer’s Society literature.

  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health. Unplanned admissions were regularly reviewed by the practice and contact could be made with the local mental health team if required.

People whose circumstances may make them vulnerable

Good

Updated 13 May 2016

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 those with a learning disability. There were 12 patients on the learning disability register, and 9 of these had received an annual health check in the last twelve months. The practice told us they telephoned these patients to arrange their reviews.

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

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Documentation supported that patients received ongoing care and support from the appropriate health care service(s).

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations. A number of self help organisation contact details were made available for patients which included domestic violence, rape crisis and the Samaritans.

  • 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.