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Inspection Summary


Overall summary & rating

Good

Updated 3 October 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Naseby Medical Centre on 19 May 2016. The overall rating for the practice was good; however, the practice was rated as requires improvement for providing responsive services. The full comprehensive report on the May 2016 inspection can be found by selecting the ‘all reports’ link for Naseby Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced desk-based focused inspection carried out on 25 August 2017 to confirm that the practice had carried out their plan to make improvements in relation to patient satisfaction, availability of non-urgent appointments and uptake of health screenings and reviews that we identified in our previous inspection on 19 May 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:

  • Since the previous inspection, the practice analysed the national patient survey result and developed an action plan. To improve patient satisfaction the practice employed a full time GP to increase appointment access, a new phone system was introduced and better use of online services were made.

  • As a result, data from the July 2017 national GP patient survey showed patient satisfaction had improved in most areas. Unverified data from internal surveys carried out by the practice also showed improvements.

  • Previously the practice uptake of national screening such as bowel and breast cancer was below local and national averages.

  • Members of the management team we spoke with explained that following a survey carried out in February 2017 to assess reasons for low uptake, the practice identified a number of barriers. For example, misunderstanding regarding the purpose of screening, literacy barriers and language barriers as well as cultural and religious reasons. As a result, greater awareness of the benefits of screening was discussed with patients. Alerts were added to patient notes which prompted clinicians to opportunistically provide health promotion and advice during appointments.

  • More effective systems for following up patients who missed screening appointments were introduced and reception staff were able to communicate with patients in various languages.

  • Data from the 2015/16 Quality and Outcomes Framework (QOF) showed that uptake rates for bowel cancer screening had declined; however breast screening slightly improved. Staff explained that they were aware of their performance and continued to educate patients on the benefits of screening. GPs were also engaging with local cancer intelligence networks to improve online literature in various languages.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 August 2016

  • There was an effective system in place for reporting and recording significant events.
  • Outcomes and learning to improve safety in the practice had been shared with staff and were discussed at relevant practice meetings (clinical or practice meetings as appropriate). Information was disseminated to all staff.
  • When there were unintended or unexpected safety incidents, people received reasonable support, information, and a verbal apology where appropriate. They were also 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 people safe and safeguarded from abuse. There was a lead member of staff for safeguarding children and vulnerable adults.
  • Risks to patients were assessed, embedded and well managed.

Effective

Good

Updated 22 August 2016

  • The practice had systems in place to keep all clinical staff up to date. Staff had access to guidelines from NICE and used this information to deliver care and treatment that met peoples’ needs.
  • Although data from the Quality and Outcomes Framework (QOF) showed that had taken steps to raise standards in some of the identified areas of improvement. In addition the practice had analysed their patient list population and were able to provide a clear rationale for the lower rates achieved in some areas.
  • We viewed six clinical audits that had been completed in the last 12 months. Three of these were completed audit cycles where the improvements made were implemented and monitored.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of completed and planned appraisals for staff.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 22 August 2016

  • The national GP patient survey published on 7 January 2016 showed that the practice performance was mixed. Patients rated the practice above average for its satisfaction scores in relation to GP consultations. However, results for consultations with the nurse and interactions with reception staff were lower than the local and national averages.
  • The response rate to the national GP patient survey was only 12% which represented 1% of the practice’s patient list. The practice had carried out their own patient survey in April 2016 which demonstrated improved satisfaction rates. Comment cards we received and patients we spoke with were also positive.

  • We found that information for patients about the services available was easy to understand and accessible.
  • We saw that staff treated patients with kindness and respect. Feedback from patients during the inspection about their care and treatment was positive.

Responsive

Good

Updated 3 October 2017

At our previous inspection on 19 May 2016, we rated the practice as requires improvement for providing responsive services. During the August 2017 desk-based follow up review we saw that patient satisfaction in most areas had improved. For example:

  • Since the previous inspection, the practice followed an action plan to address areas where patient satisfaction was lower than local and national averages. For example, the practice employed a full time GP; reviewed their phone lines and made better use of online services.
  • Data from the July 2017 national GP patient survey showed patients satisfaction had improved in most areas. For example, experience of making an appointment and GP access. The practice was aware of the issues and followed an action plan to address key areas.
  • The practice engaged with their patient participation group and carried out internal surveys between April and May 2017. Unverified data provided by the practice showed improvements in patients’ satisfaction.

Well-led

Good

Updated 22 August 2016

  • The practice had a clear vision to deliver high quality care and promote good outcomes for patients. The practice was aware of practice performance levels and changes had been made or were planned where required.
  • There was a documented leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular practice and clinical meetings.
  • The practice had carried out proactive succession planning.
  • The provider was aware of the requirements of the duty of candour. The partners encouraged a culture of openness and honesty and staff members were provided with opportunities for feedback.
  • The practice had sought feedback from patients, which it acted on. The patient participation group was active and practice patient surveys had been carried out.
  • All staff had received inductions and had either received an appraisal or had one planned.
Checks on specific services

People with long term conditions

Good

Updated 22 August 2016

  • The practice was an outlier for some long term conditions and although we saw evidence to demonstrate that the practice had reviewed the identified issues and was addressing these, improvements could not yet be demonstrated.
  • Performance for diabetes related indicators for the practice was 84% which was comparable to the CCG average of 83% and a national average of 84%. We saw evidence that the practice had set-up and established a monthly meeting with a specialist diabetic nurse and a diabetic consultant to further support these patients.
  • The percentage of patients with hypertension having regular blood pressure tests was 83% which was comparable to the CCG average of 83% and a national average of 84%.
  • Longer appointments and home visits were available when needed.
  • Patients had a personalised care plan or structured annual review to check that their health and care needs were being met.
  • For those patients with more complex needs, we identified that the GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 22 August 2016

  • Same day appointments were available for children and those with serious medical conditions.

  • The practice held monthly child health clinics jointly between the practice nurse and GP which accommodated 6-8 weeks checks and immunisations.

  • Immunisation rates for childhood vaccinations were comparable to CCG averages.

  • The practice’s uptake for the cervical screening programme was 56% which was below the CCG average of 79% and the national average of 82%. However, we saw evidence to demonstrate that the most recent uptake rates had significantly improved through the implementation of various strategies.

  • Appointments were available outside of school hours.

  • Breast feeding and baby changing facilities were available.

  • The practice also worked with health visitors and midwives to support young families.

Older people

Good

Updated 22 August 2016

  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • A facility for online repeat prescriptions and appointments bookings was available.
  • Patients were also able to book telephone consultations with the GP.
  • A weekly phlebotomy service was available at the practice for the convenience of patients requiring blood tests.
  • An electrocardiogram (ECG) service (equipment to record electrical activity of the heart to detect abnormal rhythms and the cause of chest pain) was available onsite at the practice.
  • There were longer appointments available for older patients and those over 75 were allocated a named GP.
  • There were disabled facilities available and the practice had a ramp at the entrance to the building to enable easy access for patients with mobility difficulties.
  • The GP consultation rooms were all located on the ground floor. Although the nurse consultation room was located on upstairs, the practice told us the nurse would use one of the consultation rooms downstairs if required.

Working age people (including those recently retired and students)

Good

Updated 22 August 2016

  • 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 on Mondays from 6.30pm to 7.30pm for working patients who could not attend during normal opening hours.
  • Patients were able to book telephone consultations with the GP.
  • Patients could book appointments or order repeat prescriptions online.
  • The practice offered 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)

Good

Updated 22 August 2016

  • Performance for mental health related indicators was 89% which was comparable to the CCG average and national averages of 87%.
  • There were longer appointments available for patients with dementia, a learning disability and patients experiencing poor mental health.
  • Home visits were available for patients who had clinical needs which resulted in difficulty attending the practice.
  • The practice had informed patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The GP we spoke with had good knowledge of the relevant consent and decision-making requirements of legislation and guidance, including the Mental Capacity Act 2005. We saw evidence that the GP had completed online mental capacity training.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 22 August 2016

  • The practice held a register of patients living in vulnerable circumstances and alerts were in place on the clinical patient record system.
  • Translation services were available.
  • Longer appointments were available for patients requiring an interpreter or for those with a learning disability.
  • Home visits were available for patients who had clinical needs which resulted in difficulty attending the practice.
  • Practice policies were accessible to all staff which outlined who to contact for further guidance if they had concerns about a patient’s welfare.
  • There was a lead staff member for safeguarding and we saw evidence to show that staff had received the relevant training.
  • Staff members we spoke with were able to demonstrate that they understood their responsibilities with regards to safeguarding.
  • The practice also worked with health visitors to identify children who may be vulnerable.