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Crown Wood Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 16 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Crown Wood Medical Centre on 2 March 2016. Overall the practice is rated as good.

Specifically, we found the practice good for providing safe, effective, responsive, caring and well led services.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded, monitored and reviewed.
  • Risks to patients were assessed and well managed.
  • We found that completed clinical audits cycles were driving positive outcomes for patients.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. 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.
  • Information about services and how to complain were available and easy to understand.
  • Patients said they found it easy to make an appointment with a named GP, 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 provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvements are:

  • Review and improve the systems in place to effectively monitor vaccine fridge temperatures readings.
  • Review and improve the systems in place to effectively monitor outcomes of diabetic patients.
  • Review and improve the system in place to promote the benefits of cervical, bowel and breast screening in order to increase patient uptake.
  • Ensure that within response to complaints patients are given the necessary information of the complainant’s right to escalate the complaint to the Ombudsman if dissatisfied with the response.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 March 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Staff understood their responsibilities to raise concerns, and to report incidents and near misses.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were safety incidents, patients received reasonable support, truthful information, a verbal and written apology and are 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.
  • Risks to patients were assessed and well managed.
  • Fridge temperatures were recorded daily.
  • There was an infection control protocol in place and infection control audits were undertaken regularly.

Effective

Good

Updated 16 March 2016

The practice is rated as good for providing effective services.

  • Staff assessed need and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were slightly below average for the local Clinical Commissioning Group (CCG) and compared to the national average. For example, the practice had achieved 86% of the total Quality and Outcomes Framework (QOF) points available for diabetes, compared to 95% locally and 89% nationally.
  • However, we witnessed the practice had implemented diabetic management plans and demonstrated improvements in diabetic patient’s outcomes. The practice was planning to roll out a ‘year of care’ initiative for diabetes patients to increase compliance with treatments and the improved management of their conditions.
  • The practice’s uptake of the national screening programme for cervical, bowel and breast cancer screening were below national average. For example, breast screening uptake was 66%, which was below the national average of 72%.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patient’s needs.

Caring

Good

Updated 16 March 2016

The practice is rated as good for providing caring services.

  • Data showed that patient outcomes were mixed compared to others in locality for several aspects of care.
  • 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 easy to understand and accessible.
  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 16 March 2016

The practice is rated as good for providing responsive services.

  • It 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. For example, the practice had developed an extension plan to build an additional two consulting rooms with additional admin space in the current premises. The practice had secured the funding, planning permission had been granted and building work was due to start in March 2016.
  • Patients said they found it easy to make an appointment with a named GP, with urgent appointments available the same day.
  • 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 that the practice responded quickly to issues raised. However, the practice had not always included necessary information of the complainant’s right to escalate the complaint to the Ombudsman if dissatisfied with the response. Learning from complaints was shared with staff and other stakeholders.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet people’s needs.

Well-led

Good

Updated 16 March 2016

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

  • There was a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff 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 practice was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents
  • The practice proactively sought feedback from staff and patients, which it acted on. There was an active patient participation group.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 16 March 2016

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

  • There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Longer appointments and home visits were available when needed.
  • All patients with long term conditions had a named GP and a structured annual review to check that 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.

Families, children and young people

Good

Updated 16 March 2016

The practice is rated as good for the care of families, children and young patients.

  • 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 patients who had a high number of A&E attendances.
  • Immunisation rates were comparable for all standard childhood immunisations.
  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.
  • The practice’s uptake for the cervical screening programme was 80%, which was lower than the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw good examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 16 March 2016

The practice is rated as good for the care of older patients.

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.
  • It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The percentage of patients aged 65 or over who received a seasonal flu vaccination was higher (80%) than the national average (73%).
  • There was a register to manage end of life care.
  • There were good working relationships with external services such as district nurses.

Working age people (including those recently retired and students)

Good

Updated 16 March 2016

The practice is rated as good for the care of working-age patients (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 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.
  • Extended hours appointments were available every Monday evening from 6:30pm to 7:30pm. In addition, the practice offered extended hours appointments as a part of clinical commissioning group (CCG) overflow service arrangements from 6:30pm to 8:30pm (Monday to Friday) and 8am to 4pm (every Saturday).

People experiencing poor mental health (including people with dementia)

Good

Updated 16 March 2016

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

  • Performance for dementia face to face review was better than the CCG and national average. The practice had achieved 94% of the total number of points available, compared to 83% locally and 84% nationally.

  • 92% of patients experiencing poor mental health were involved in developing their care plan in last 12 months.
  • 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 how to access various support groups and voluntary organisations.
  • Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.
  • 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 16 March 2016

The practice is rated as good for the care of patients whose circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including homeless patients, travellers and those with a learning disability.
  • It offered annual health checks for patients with learning disabilities. Health checks were completed for all three patients on the learning disability register.
  • Longer appointments were offered to patients with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.
  • It had told 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.