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Archived: Heald Green Health Centre 2 Good Also known as Dr Wright & Partners

Inspection Summary


Overall summary & rating

Good

Updated 12 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Heald Green Health Centre 2 on 30 November 2016. At the inspection in November the overall rating for the practice was good, although the key question Safe was rated requires improvement. This was specifically in relation to the management of medicines that required patients to receive regular health care checks and the systems to ensure medicines were changed and checked appropriately when requested by a secondary care provider such as a hospital consultant. We also identified some areas where the practice could improve other aspects of the service they provided. The full comprehensive report on the November 2016 inspection can be found by selecting the ‘all reports’ link for Heald Green Health Centre 2 on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 9 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 30 November 2016. This report covers our findings in relation to those requirements and also the additional improvements made by the practice since our last inspection.

The practice is now rated as good for providing safe services, and overall the practice is rated as good.

Our key findings were as follows:

  • Since the previous inspection the practice had employed a pharmacist to assist the GPs with the management of medicines. This included identifying and monitoring those patients who required regular health checks and those patients discharged from hospital with changes to their prescribed medicines.
  • A protocol had been established so that prescriptions for repeat requests for medicines such as for example Warfarin (blood thinning medicine) were only issued if an up to date blood result (INR)was available.
  • The systems to ensure the practice received Warfarin blood results in a timely manner had been reviewed and improved communication links had been established with a local hospital that carried out the INR blood testing.
  • Patients prescribed other high risk medicines such as disease-modifying anti-rheumatic drugs (DMARDs) were monitored with monthly searches on patient records to ensure the appropriate checks such as blood tests had been undertaken. In addition a screen message had been added to each patient’s electronic record so that staff could easily identify those patients requiring these checks.
  • The practice management team had reviewed their procedure in relation to monitoring and responding to pathology tests results. The practice ensured that all pathology test results were allocated out to those GPs on duty each day. This ensured that these were checked within the appropriate timescale.
  • The practice had made improvements to the practice’s record systems. For example a safety alert log was now established and accessible to staff. This provided a brief record of actions taken and hyperlinks to the relevant documents.
  • The practice also maintained a log of significant events with a brief description of the incident and log of action taken all staff. A log of all meetings was also maintained.
  • The practice had undergone some staff changes since the last inspection and this had enabled the practice to review its staffing establishment and the activities undertaken by the different staff teams. This had resulted in a streamlining of the nursing team and appointments scheduling and a change in how GP appointments were scheduled.
  • As part of the local Clinical Commissioning Group (CCG) initiative the practice has had a new telephone system installed however the additional benefits from the system had yet to be ‘switched’ on by the CCG.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 July 2017

The practice is rated as good for providing safe services.

  • The practice had taken action to improve the safe management of medicines. Actions included the recruitment of a practice based pharmacist, implementation of systems to regularly monitor patients prescribed high risk medicines so that these patients received the necessary health checks.
  • The practice had updated it systems to monitor daily pathology test results received.
  • Systems to record safety alerts, significant events and the actions taken in response had improved. The improvements ensured these were accessible to staff.
  • The appointment system for both GP and nurse patient appointments had been reviewed and streamlined to provide a more effective system.

Effective

Good

Updated 20 February 2017

The practice is rated as good for providing effective services.

  • Patients’ needs were assessed and care was planned and delivered 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.

  • The system for managing results from secondary care required review.

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

  • Clinicians met on a regular basis to review the needs of patients and the clinical care and treatment provided.

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

  • Staff felt well supported overall and they had been trained to provide them with the skills, knowledge and experience to deliver effective care and treatment. However, staff found some aspects of their role more challenging as a result of working across two practices.

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

Caring

Good

Updated 20 February 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 respect and maintained confidentiality.

  • Data from the national patient survey showed that patients rated the practice similarly to other practices locally and nationally for aspects of care. For example, having tests and treatments explained and for being treated with care and concern.

  • Information was provided to patients about the services available to them.

  • The practice maintained a register of patients who were carers in order to tailor the services provided. For example to offer them immunisations.

  • Patients who had carer responsibilities were signposted to a local carers’ support group.

Responsive

Good

Updated 20 February 2017

The practice is 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.

  • Some of the patients we spoke with said they found it difficult to get through to the practice to make an appointment. This was reflected in the national patient survey.The practice was in the process of getting a new phone system installed which was hoped would improve this. Overall, patients told us they could get an appointment if they needed one. However, some patients felt they had to wait too long for a routine appointment.

  • Urgent and routine appointments were available the same day and routine appointments could be booked in advance.

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

  • The practice responded quickly to complaints issues raised and learning from complaints was acted upon.

Well-led

Good

Updated 20 February 2017

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

  • The practice had a vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about their responsibilities in relation to this.

  • There were systems in place to govern the practice and support the provision of good quality care. However, some aspects of medicines management required improvement.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty.

  • The practice used feedback from staff and patients to make improvements.

  • The patient participation group (PPG) was active and they gave us examples of how the practice had made changes in response to their feedback.

  • There was a focus on learning, development and improvement linked to 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 20 February 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.

  • Practice nurses held dedicated lead roles for chronic disease management. As part of this they provided regular, structured reviews of patients’ health.

  • Patients with several long term conditions could be offered a single, longer appointment to avoid multiple visits to the surgery.

  • Data from 2015 to 2016 showed that the practice was performing in comparison with other practices nationally for the care and treatment of people with chronic health conditions.

  • The practice held regular multi-disciplinary meetings to discuss patients with complex needs and patients receiving end of life care.

  • One of the practice nurses led on supporting pre-diabetic patients and they were looking to develop this aspect of the service further.

  • The practice provided an in house phlebotomy service which was convenient for patients especially those requiring regular blood monitoring.

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

Families, children and young people

Good

Updated 20 February 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.

  • A GP was the designated lead for child protection. All hospital letters for children were assigned to the lead GP in order to identify any child protection concerns.

  • Staff we spoke with had appropriate knowledge about child protection and they had ready access to safeguarding policies and procedures.

  • Regular safeguarding meetings took place with health visitors to share information or concerns about child welfare.

  • Child health surveillance clinics were provided for 6-8 week olds.

  • Immunisation rates were comparable to the national average for all standard childhood immunisations. One of the practice nurses monitored non-attendance of babies and children at vaccination clinics and they told us they would report any concerns they identified to relevant professionals.

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

  • The premises were suitable for children and babies and baby changing facilities were available.

  • Family planning services were provided.

  • The percentage of women aged 25-64 whose notes recorded that a cervical screening test had been performed in the preceding five years was 94% which was higher than the national average of 81%.

Older people

Good

Updated 20 February 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.

  • The practice provided a range of enhanced services, for example, the provision of care plans for patients at risk of an unplanned hospital admission.

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were similar to outcomes for patients locally and nationally.

  • GPs carried out regular visits to a local nursing home to assess and review patients’ needs and to prevent unplanned hospital admissions.

  • 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.

  • Two of the GP partners had an interest in end of life care.

Working age people (including those recently retired and students)

Good

Updated 20 February 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.

  • The practice provided extended hours appointments three days per week to accommodate working patients.

  • 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.

  • 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 20 February 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 better than local and national averages.

  • The practice worked with other health and social care professionals in the case management of people experiencing poor mental health, including those with dementia.

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

  • A system was in place to follow up patients who had attended accident and emergency and this included where people had been experiencing poor mental health.

  • Patients experiencing poor mental health were informed about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 20 February 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 worked with other health and social care professionals in the case management of vulnerable people.

  • Regular safeguarding meetings were held that covered both children and vulnerable adults.

  • 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.

  • The practice provided appropriate access and facilities for people who were disabled.

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