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Meden Medical Services Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 28 September 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Meden Medical Services on 16 December 2015. The practice was rated as requires improvement overall. The fully comprehensive report on the December 2015 inspection can be found by selecting the ‘all reports’ link for Meden Medical Services on our website at www.cqc.org.uk.

We carried out a further announced comprehensive inspection at Meden Medical Services on 27 June 2017. Overall the practice is rated as requires improvement.

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

  • There was a system in place for reporting and recording significant events. However, there had been no significant events reported or reviewed since December 2016 for both the main and branch surgeries.

  • Data showed patient outcomes were low compared to the national average.

  • Data from the GP patient survey showed that patients rated the practice lower than average for several aspects of care. However, patients we spoke with said they were treated with compassion and respect and were involved in their care and decisions about their treatment. Feedback received from 18 CQC patient comment cards were all positive about their experience of the practice.

  • Information about services and how to complain was available and easy to understand.

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

  • The practice provided a range of services to meet the needs of its population. For example, the practice offered a minor injuries service.

  • There was a leadership structure in place and staff told us they felt supported by management.

  • The practice sought feedback from staff and patients, which it acted on. The practice had an active patient participation group (PPG) in place who met on a regular basic and carried out patient surveys in the patient waiting area.

The areas where the provider must make improvements are:

  • Address the issues highlighted in the national GP survey in order to improve patient satisfaction, including appointment access and consultations with GPs and nurses.

  • Ensure there is an effective system in place to manage and monitor processes to improve outcomes for patients.

  • Review process in place to ensure blank prescription forms are tracked throughout the practice.

In addition the provider should:

  • Continue to review the process for significant events on a regular basis to ensure any themes or trends are identified and learning has been embedded.

  • Provide practice information to patients in particular in relation to the practice zero tolerance policy for patients.

  • Ensure that safety updates from the MHRA received by the practice, are disseminated to relevant members of staff ensuring adequate records are held to evidence that relevant staff have received these alerts and actions taken as necessary.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for providing safe services.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, there had been no further significant events recorded since December 2016.

  • The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • The practice had a process in place in relation to alerts received from the Medicines and Healthcare Products Regulatory Agency (MHRA)  During our inspection, we saw examples of various alerts received however, we did not see any evidence of dissemination of MHRA alerts or evidence that staff had received and acted upon them appropriately.

Effective

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for providing effective services, as there are areas where improvements should be made.

  • Data showed patient outcomes were low compared to the national average. For example data from the QOF showed performance for diabetes related indicators was 76% which was lower than the CCG average of 85% and the national average of 90%. Performance for chronic obstructive pulmonary disease related indicators was 84% which was lower than the CCG average of 93% and the national average of 96%.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff with the exception of one clinician who required an appraisal.

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

Caring

Good

Updated 28 September 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice comparable to others for several aspects of care.

  • In 2016, a GP received a ‘kindness’ award presented by NHS Mansfield and Ashfield CCG and was nominated for this award by patients of the practice.

  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 65 patients as carers (1% of the practice list).

  • Staff told us that if families had experienced bereavement, their usual GP contacted and carried out bereavement home visits.

  • Survey information we reviewed showed that 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 available was accessible.

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

  • We spoke with two patients and received 18 comment cards which indicated that patients felt they were treated with compassion and respect and were involved in decisions about care and treatment.

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

Responsive

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for providing responsive services.

  • Results from the GP patient survey showed that patients’ satisfaction with access to the practice was below local and national averages.

  • The practice provided a range of services to meet the needs of its population. For example, the practice offered a minor injuries service.

  • 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 the practice responded quickly to issues raised.

  • The practice offered extended hours on a Monday to Thursday from 7am until 8.30am each day and from 6.30 until 7.30pm on a Tuesday each week at the Meden Vale surgery for working patients who could not attend during normal opening hours.

Well-led

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for being well-led.

  • There was a vision to deliver high quality care which was shared with patients on their website and in the patient guide.

  • The practice provided us with a copy of a practice action plan following our last inspection in December 2015 which highlighted areas for improvement and actions taken to address these areas. Although we saw that there had been improvement in some areas, there were still a number of areas which required further review and improvement.

  • The practice had a number of policies and procedures to govern activity and held regular meetings.

  • There were governance systems in place which supported the delivery of care. However, some of these systems needed to be strengthened.

  • The practice sought feedback from staff and patients, which it acted on. The patient participation group was active.

Checks on specific services

People with long term conditions

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for the care of people with long-term conditions. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

  • Longer appointments and home visits were available when needed.

  • Performance for diabetes related indicators was 76% which was lower than the CCG average of 85% and the national average of 90%.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The practice had a clinical prevalence of chronic obstructive pulmonary disease (COPD) which was significantly above the national average. (COPD is the name for a collection of lung diseases). However, performance for indicators to measure the management of COPD was below local and national averages. For example, performance for chronic obstructive pulmonary disease related indicators was 84% which was lower than the CCG average of 93% and the national average of 96%.

Families, children and young people

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for the care of families, children and young people. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

  • There were systems 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 accident and emergency (A&E) attendances.

  • Childhood immunisations were carried out in line with the national childhood vaccination programme. Uptake rates for the vaccines given were comparable to CCG/national averages. For example, rates for the vaccines given to under two year olds ranged from 91% to 94% which was above the national expected standard of 90%.

  • The practice’s uptake for the cervical screening programme was 81%, which was comparable with the CCG average of 84% and the national average of 81%.

  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

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

  • The practice worked with midwives, health visitors and school nurses to support this population group. For example, in the provision of ante-natal, post-natal and child health surveillance clinics.

  • The practice had made efforts to engage with young people and had a noticeboard dedicated to under 16s.

Older people

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for the care of older people. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

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

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for the care of working age people (including those recently retired and student). The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

  • 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.

  • The practice offered extended hours services three mornings per week from 7am and until 7.30pm one evening per week at one of its two sites.

  • The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for the care of people experiencing poor mental health. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

  • In 2014-15, performance for mental health related indicators was 69.2% which was 21.9% below the CCG average and 23.6% below the national average. Data for 2015-16 demonstrated that the practice had made improvements however, performance was still below local and national averages in respect of mental health related indicators. For example, performance for mental health related indicators was 84% which was lower than the CCG average of 89% and the national average of 93%.

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

  • 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.

People whose circumstances may make them vulnerable

Requires improvement

Updated 28 September 2017

The practice is rated as requires improvement for the care of people whose circumstances may make them vulnerable. The service is rated as requires improvement for providing safe, effective, responsive and well led services and good for providing caring services. The evidence which led to these ratings applies to all population groups, including this one.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

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

  • The practice had information for 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.