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Queslett Medical Centre Good Also known as Queslett Surgery

Inspection Summary


Overall summary & rating

Good

Updated 7 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Queslett Medical Centre on 19 September 2016. The overall rating for the practice was good. The full comprehensive report on the September 2016 inspection can be found by selecting the ‘all reports’ link for Queslett Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based review carried out on 11 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 19 September 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice continues to be rated as good.

Our key findings were as follows:

  • The practice operated effective systems for reporting and recording significant events. Significant event logs showed that the practice had responded and learned from safety incidents.
  • Effective systems were in place to receive, act on and disseminate alerts from the Medical and Healthcare products Regulatory Agency (MHRA). Members of the management team provided documentation which showed that appropriate actions had been taken and outcomes shared within the practice.
  • When we carried out our September 2016 comprehensive inspection data we viewed showed that the practice uptake for national screening programmes such as bowel and breast cancer was below local and national average. As part of this desk-based review members of the management team we spoke with explained that the practice continued working closely with the health promotion team to encourage uptake. For example, we were told that staff actively monitored attendance and actively contacted patients who failed to attend their screening appointments. The practice provided evidence of posters which they placed in the reception area advising patients of future screening dates.

  • The practice provided unverified data from 2015/17 screening round which showed that 32 patients were invited for breast screening, 45% attended; 47% were allocated a second appointment and 13% opted out.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 June 2017

At our previous inspection on 19 September 2016, we rated the practice as requires improvement for providing safe services as the arrangements in respect of responding to patient safety alerts such as Medicines and Healthcare products Regulatory Agency (MHRA) and maximising learning from significant event were not adequate. These arrangements had significantly improved when we undertook a follow up inspection on 11 May 2017. For example:

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.

  • Documentations we viewed showed effective systems for reporting and recording significant events. We saw that lessons were shared to help improve safety in the practice and when things went wrong patients were informed.

  • The practice operated an effective system for managing and disseminating patient safety alerts. Members of the management team provided evidence which demonstrated actions taken to ensure compliance with safety alerts.

Effective

Good

Updated 7 June 2017

Caring

Good

Updated 7 June 2017

Responsive

Good

Updated 7 June 2017

Well-led

Good

Updated 7 June 2017

Checks on specific services

People with long term conditions

Good

Updated 28 December 2016

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

  • Performance for diabetes related indicators was similar to the national average. For example 82% had a specific blood glucose reading within acceptable range in the preceding 12 months (01/04/2014 to 31/03/2015) compared to the CCG and national average of 78%. With an exception reporting rate of 19%, compared to CCG average of 9% and national average of 12%.

  • The percentage of patients with diabetes, on the register, who have had influenza immunisation in the preceding 1 August to 31 March (01/04/2014 to 31/03/2015), was 98%, compared to CCG and national average of 94%.

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and a structured annual review to check their health and medicines needs were being met. 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.

  • The practice offered a range of services in-house to support the diagnosis and monitoring of patients with long term conditions including spirometry, phlebotomy and nurse consultations.

  • The practice pro-actively identified patients at risk and carried out pre-diabetic checks. Identified patients were referred to a range of services such as health exchange and Be Active exercise programme. 

Families, children and young people

Good

Updated 28 December 2016

  • 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 were comparable for all standard childhood immunisations for children under two; with the exception of children aged five years where results were below CCG and national averages for some immunisations

    . For example, Infant Men C for five year olds was 57% compared to CCG average of 75% and national average of 83%.

  • The practice was accessible for pushchairs, had baby changing facilities and supported breast-feeding. Information for expectant mothers regarding early antenatal care were available and the practice promoted the uptake of flu and pertussis (Whooping Cough) vaccinations.

  • Staff we spoke with were able to demonstrate how they would ensure children and young people were treated in an age-appropriate way and that they would recognise them as individuals.

  • The practice’s uptake for the cervical screening programme (2014/15) was 73%, which was below the CCG average of 80% and national average of 82%.

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

  • The practice provided a confidential contraception service for young people.

  • The practice developed their safeguarding protocol to include Identification and Referral to Improve Safety (IRIS) referral pathway for patients at experiencing or at risk of domestic violence.

Older people

Good

Updated 28 December 2016

  • The practice offered proactive, personalised care to meet the needs of the older people in its population. All patients had access to a named GP.

  • The practice was responsive to the needs of older people, and offered home visits, same day telephone consultation, early prescription requests and urgent appointments for those with enhanced needs.

  • Clinical staff had had received medicines poly-pharmacy training.

  • The practice had a designated lead responsible for working with relevant associated health professionals to deliver a multidisciplinary package of care to meet of this population group.

  • The practice provided health promotion advice and literature which signposted patients to local community groups and charities such as Age UK.

  • The practice routinely discussed any unplanned admissions including those from care homes to ensure their care needs were being appropriately met.

  • The practice was accessible to those with mobility difficulties.

Working age people (including those recently retired and students)

Requires improvement

Updated 28 December 2016

  • The uptake rates for national screening programmes such as breast and bowel screening were below local and national averages. The practice did not have an effective process in place to improve uptake for this population group.

  • 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 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.

  • The practice offered a late clinic on Mondays from 6.30pm to 7pm these were specifically aimed at patients who were unable to attend during normal practice hours.

  • The practice offered a range of health promotion and screening that reflected the needs for this age group.

  • The practice provided new patient health checks and routine NHS health checks for patients aged 40-74 years.

  • Data from the national GP patient survey indicates that the practice were above the local and national averages for phone access however below average for opening hours.

  • The practice were involved in a Clinical Commissioning Group (CCG) pilot to develop a Hub model aimed at improving services and patient access within the area.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 December 2016

  • Nationally reported data for 2014/15 showed 100% of patients diagnosed with dementia had their care reviewed in a face-to-face meeting in the last 12 months. This was above the local and national average, with a 0% exception reporting rate.

  • Nationally reported data for 2014/15 showed 100% of patients on the practice’s mental health register had a comprehensive, agreed care plan documented in the preceding 12 months. This was above the CCG and national average, with an 8% exception reporting rate compared to CCG average of 5% and national average of 13%.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients 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 such as Birmingham healthy Minds and Forward Thinking Birmingham.

  • 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.

  • Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia and there was a designated lead responsible for this population group.

People whose circumstances may make them vulnerable

Good

Updated 28 December 2016

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability (LD). Data provided by the practice showed that all patients with a LD had a care plan, medicine and face-to-face review in the last 12 months.

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

  • An alert system was used to identify patients at risk or with special requirements that needed additional support.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff we spoke with 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.

  • Carers of patients registered with the practice had access to a range of services, for example annual health checks, flu vaccinations and a review of their stress levels. Data provided by the practice showed that 1.5% of the practice list were carers.