Hawthorn Medical Centre

We carried out an announced inspection at Hawthorn Medical Centre on 21 & 22nd June 2022. Overall, the practice is rated as Outstanding.

The ratings for each key question are:

Safe - Good

Effective – Good

Caring –Good

Responsive ––Outstanding

Well-led – Outstanding

Why we carried out this inspection

This inspection was a rating inspection to check the provider was complying with the regulations under the Health and Social Care Act 2008. We inspected five key questions to determine if the service is safe, effective, caring, responsive and well led.

How we carried out the inspection

Throughout the pandemic CQC has continued to regulate and respond to risk. However, taking into account the circumstances arising as a result of the pandemic, and in order to reduce risk, we have conducted our inspections differently.

This inspection was carried out in a way which enabled us to spend a minimum amount of time on site. This was with consent from the provider and in line with all data protection and information governance requirements.

This included:

• Using questionnaires sent to staff prior to the on-site visit;
• Speaking to staff in person;
• Completing clinical searches on the practice’s patient records system and discussing findings with the provider;
• Reviewing patient records to identify issues and clarify actions taken by the provider;
• Requesting evidence from the provider;
• A shorter site visit

Our findings

We based our judgement of the quality of care at this service on a combination of:

• what we found when we inspected
• information from our ongoing monitoring of data about services and
• information from the provider, patients, the public and other organisations.

We found that:

We rated the practice as good for providing safe services because:

• The practice provided care in a way that kept patients safe and protected them from avoidable harm.

We rated the practice as good for providing effective services because:

• Patients received effective care and treatment that met their needs.

We rated the practice as good for providing caring services because:

• Staff dealt with patients with kindness and respect and involved them in decisions about their care

We rated the practice as outstanding for providing responsive services because:

• The provider introduced a Parent and Family service in 2020. The aim was to support patients from the start of pregnancy, through to their child’s first year of life. The practice approached a local charity and forged a working partnership. This was achieved with a range of social and health interventions. A clinical psychologist led the service and ran a range of services and clinics including:
• A support service for families who had suffered miscarriage, stillbirths and racial trauma.
• Weekly cognitive behavioral therapy (CBT talking therapy) sessions for patients/ families.
• Antenatal group sessions, which provided latest information about babies, support to parents and helped to build a healthy relationship with their baby.
• Personlised sessions which helped adjust from pregnancy to being a parent, bonding between child and parent and managing emotions such as anxiety, guilt and anger issues.

In January 2021, the practice produced a 12-page annual review evaluation. The review identified that no babies had been taken into care and no families were the subject of active safeguarding procedures.. Additionally, no parents had been detained under the Mental Health Act.

• There was a responsive and proactive approach to understanding the needs and preferences of different groups of patients and to delivering care in a way that meets these needs. For example, the practice had developed a diabetes taskforce to help treat the high number of adults with diabetes in the practice. This was a result of the nursing team identifying that patient knowledge on diabetic care was very limited due to language issues. The practice felt the clinical care provided could be more responsive and introduced a GP lead taskforce. We noted that:
• The last audit findings highlighted that 50 patients had bloods levels (HBA1c) above 75mmol. Three months after taskforce interventions, records showed a vast reduction in 20 patients’ blood glucose levels.
• The practice utilised industry recognised templates to ensure they achieved quality assurance standards named the ‘nine points of diabetic care’. This showed an increase of 12% in the effective care patients received over a three month period.
• The practice introduced one hour appointments where patients were seen by a GP and nurse in the same clinic.
• The practice supported many local charities in the community. For example, the practice recently forged a partnership with a local homeless family charity, who provided temporary accommodation for homeless families in the Greater Manchester area. The practice designed and introduced an easy registration process. Resulting in families receiving immediate access to care. We were provided with examples from the GPs of positive interventions, For example we saw the GP liased with multiple services and authorities, which helped permentaly re-home a family.
• Community involvement and support were the key for the practice. For example, the practice developed and introduced the focus worker. Each focus worker produced a good news and progression record were clearly auditable. Community funday events were held, with a large community attendance and involvement.
• Quality and integrity were a high priority resulting in a holistic responsive and caring culture within the practice. This was demonstrated throughout the inspection by staff interviews, feedback from local communities and patient feedback on care received. We heard many examples of staff responding to patients needs. For example: a food bank was introduced, during COVID and staff supported the shielding with help and support. We were told of staff members who volunteer to help support patients, whilst on hospital visits were language barriers may be an issue.

We rated the practice as outstanding for providing well led services because:

• The provider had carried out an analysis of the local area and population and had an excellent understanding of the challenges faced in their area and tailored their service to meet these needs.
• There was a strategy in place to continue to improve the delivery of high-quality care and treatment at practice and provider level and the whole team was involved in strategy discussions. This included a recovery from COVID plan.
• Governance and performance management arrangements were reviewed regularly and all staff, including temporary staff, had access to all the information they required to carry out their duties.
• Leadership, governance and culture was used to drive and improve the delivery of high-quality person-centred care.
• Feedback from staff was consistently positive. Staff felt able to raise concerns and we saw examples of this happening. Staff felt empowered to drive improvement and they had the support of the leadership team when doing this.
• Staff were valued within the organisation and given the opportunity to develop and progress professionally both in clinical and non-clinical roles.

Whilst we found no breaches of regulations, the provider should:

• Continue to monitor, review and improve childhood immunisations targets.
• Continue to monitor, review and improve cervical screening targets.