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Inspection Summary


Overall summary & rating

Good

Updated 17 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Grove Hill Medical Centre on 31 August 2016. The overall rating for the practice was good. However, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided well-led services. Consequently the practice was rated as requires improvement for being well-led. The full comprehensive report from the 31 August 2016 inspection can be found by selecting the ‘all reports’ link for Grove Hill Medical Centre on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice wrote to us and submitted an action plan outlining the actions they would take to meet legal requirements in relation to;

  • Regulation 17 Health & Social Care Act 2008 (Regulated Activities) Regulations 2014

- good governance.

The areas identified as requiring improvement during our inspection in August 2016 were as follows:

  • Ensure that a Legionella risk assessment is completed and that any issues identified are resolved and that water temperature checks are completed correctly.
  • Ensure that infection control audits are fully completed and that the issues identified and actions in place to resolve them are clear.
  • Ensure sufficient quality assurance processes are in place, including implementing a structured programme of repeat cycle clinical audit.
  • Ensure there is a formal and coordinated practice wide process in place for how staff access guidelines from NICE and use this information to deliver care and treatment.
  • Ensure that at all times sufficient processes are in place and adhered to for the management and review of results received from secondary care services.

In addition, we told the provider they should:

  • Ensure that all staff employed are supported by completing the essential training relevant to their roles, including safeguarding adults training.
  • Take steps to ensure that hot water temperatures at the practice are kept within the required levels.
  • Ensure that at least one piece of photographic proof of identification is included in the personnel file of each member of staff.
  • Ensure that checks on all emergency equipment are documented and that the Resuscitation Council guidelines displayed at the practice are up to date.
  • Continue to identify and support carers in its patient population by providing annual health reviews.
  • Ensure that, where practicable and appropriate, all reasonable adjustments are made for patients with a disability in line with the Equality Act (2010).

We carried out an announced focused inspection on 5 April 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches of regulation that we identified in our previous inspection on 31 August 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Our key finding on this focused inspection was that the practice had made improvements since our previous inspection and were now meeting the regulation that had previously been breached.

The practice is now rated as good for providing well-led services.

On this inspection we found:

  • Clinical audit demonstrated quality improvement.
  • Appropriate Legionella and water temperature management processes were in place. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
  • The latest infection control audit was fully completed and the issues identified and any actions in place to resolve them were clearly detailed.
  • A coordinated practice wide process was in place to ensure that staff had access to National Institute for Health and Care Excellence (NICE) guidelines and used this information to deliver care and treatment that met people’s needs.
  • Sufficient processes were in place and adhered to for the management and review of results received from secondary care services.

Additionally where we previously told the practice they should make improvements our key findings were as follows:

  • All staff had completed adult safeguarding training.
  • Personnel files contained appropriate photographic proof of identification.
  • A documented log of the weekly checks on the defibrillator was available and well completed.
  • Up to date Resuscitation Council guidelines were displayed at the practice and staff were aware of any changes from the previous version.
  • Sufficient arrangements were in place to identify carers in the practice’s patient population and offer them an annual health review.
  • A portable hearing loop was provided.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 November 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Lessons learnt were shared to make sure action was taken to improve safety in the practice.
  • When there were unexpected safety incidents, patients received reasonable support and truthful information. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice had systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Appropriate recruitment processes were in place. However, some staff files lacked one or more pieces of photographic identification.
  • Risks to patients were assessed. However, the practice did not respond appropriately to its original Legionella risk assessment. Water temperature checks were completed incorrectly and hot water temperatures were below required levels. Although regular infection control audits were completed, the issues identified from the last audit and the actions in place to resolve them were not always clear.
  • Adequate arrangements were in place to deal with emergencies. However, checks on the defibrillator were not always documented and the Resuscitation Council guidelines displayed were out of date.

Effective

Good

Updated 28 November 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were mostly better than local and national averages. The practice’s exception reporting was in line with or below local and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance. However, there was no formal and coordinated practice wide process in place for how staff accessed guidelines from NICE and used this information to deliver care and treatment.
  • The practice participated in local audits which demonstrated quality improvement. However, some quality assurance processes were insufficient. There was no structured programme of repeat cycle clinical audit at the practice.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for staff.
  • Staff worked with multi-disciplinary teams to understand and meet the range and complexity of patients’ needs.
  • The practice’s governance and monitoring processes had failed to detect that for a relatively short period of time, some patients’ pathology results had been assigned to a GP who was no longer working at the practice.

Caring

Good

Updated 28 November 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey published in July 2016 showed that with one exception, patients rated the practice similar to local and national averages for all aspects of care. Senior staff at the practice were aware of the below average satisfaction score in one area and could demonstrate they were responding to it.
  • 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice had identified 66 patients on the practice list as carers. This was approximately 1.4% of the practice’s patient list. Of those, 40 were invited for and 16 (24%) had accepted and received a health review in the past 12 months. Although efforts were being made by the practice, the number of carers identified and receiving a health review could be improved.

Responsive

Good

Updated 28 November 2016

The practice is rated as good for providing responsive services.

  • Practice staff 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.
  • Data from the National GP Patient Survey published in July 2016 showed that patients rated the practice in line with local and national averages for access to the practice. Most patients said they found it easy to make an appointment with a named GP and get through to the practice by phone and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. However, there was no hearing loop available at the practice.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 17 May 2017

At our comprehensive inspection on 31 August 2016, we identified breaches of legal requirements. Improvements were needed to systems, processes and procedures to ensure the practice provided well-led services. During our focused inspection on 5 April 2017 we found the provider had taken action to improve and the practice is rated as good for providing well-led services.

The governance arrangements in place at the practice ensured that:

  • Clinical audit demonstrated quality improvement.
  • Appropriate Legionella and water temperature management processes were in place. (Legionella is a term for a particular bacterium which can contaminate water systems in buildings).
  • The latest infection control audit was fully completed and the issues identified and any actions in place to resolve them were clearly detailed. There was evidence that action was taken or in progress to address any improvements identified as a result.
  • A coordinated practice wide process was in place to ensure that staff had access to National Institute for Health and Care Excellence (NICE) guidelines and used this information to deliver care and treatment that met people’s needs.
  • Sufficient processes were in place and adhered to for the management and review of results received from secondary care services.
  • All staff had completed adult safeguarding training.
  • Personnel files contained appropriate photographic proof of identification.
  • A documented log of the weekly checks on the defibrillator was available and well completed.
  • Up to date Resuscitation Council guidelines were displayed at the practice and staff were aware of any changes from the previous version.
  • Sufficient arrangements were in place to identify carers in the practice’s patient population and offer them an annual health review. The practice had identified 76 patients on the practice list as carers. This was approximately 1.6% of the practice’s patient list. Of those, all were invited for and 20 (26%) had accepted and received a health review. This represented an increase in the amount of carers identified and in the amount being invited for a health review since our inspection in August 2016.
  • A portable hearing loop was provided.
Checks on specific services

People with long term conditions

Good

Updated 28 November 2016

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • 88% of patients on the asthma register had their care reviewed in the last 12 months. This was above the CCG average of 76% and the national average of 75%.
  • Performance for diabetes related indicators was above the CCG and national averages. The practice achieved 98% of the points available compared to the CCG average of 91% and the national average of 89%.
  • All newly diagnosed patients with diabetes were managed in line with an agreed pathway.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and a structured six monthly review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GPs worked with relevant health and care professionals to deliver a multi-disciplinary package of care.

Families, children and young people

Good

Updated 28 November 2016

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 who may be at risk, for example, children and young people who had a high number of A&E attendances. Immunisation rates were comparable to other practices in the local area for all standard childhood immunisations.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The practice’s uptake for the cervical screening programme was 81% which was comparable to the CCG average of 83% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • There were six week post-natal checks for mothers and eight week checks for their children.
  • A range of contraceptive and family planning services were available.

Older people

Good

Updated 28 November 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.
  • The practice was responsive to the needs of older people and offered home visits and urgent appointments for those with enhanced needs.
  • Older people had access to targeted immunisations such as the flu vaccination. The practice had 585 patients aged over 65 years. Of those 383 (65%) had received the flu vaccination at the practice in the 2015/2016 year.
  • There were named GPs for each of the care homes in the practice’s local area. The GPs visited as and when required to ensure continuity of care for those patients with scheduled visits every six months to complete health reviews for those patients.  

Working age people (including those recently retired and students)

Good

Updated 28 November 2016

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 offered online services such as appointment booking and repeat prescriptions as well as a full range of health promotion and screening that reflects the needs for this age group.
  • There was some additional out of working hours access to meet the needs of working age patients. There was extended opening every Wednesday until 7.30pm. 

People experiencing poor mental health (including people with dementia)

Good

Updated 28 November 2016

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

  • 92% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months. This was above the CCG and national average of 85%.
  • Performance for mental health related indicators was better than the CCG and national averages. The practice achieved 100% of the points available compared to the CCG average of 96% 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.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • The practice referred patients as required to mental health trust well-being workers based elsewhere.
  • There was a GP lead for dementia.

People whose circumstances may make them vulnerable

Good

Updated 28 November 2016

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 including those with a learning disability. There were 14 patients on the practice’s learning disability register at the time of our inspection and all had received a health review in the past 12 months (the practice completed the reviews every six months).
  • The practice offered longer appointments for patients with a learning disability and there was a GP lead for these patients.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice informed 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.
  • Additional information was available for patients who were identified as carers and there was a nominated staff lead for these patients.
  • The practice had identified 66 patients on the practice list as carers. This was approximately 1.4% of the practice’s patient list.