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Inspection Summary


Overall summary & rating

Good

Updated 15 November 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Enki Medical Practice on 11 February 2016. The overall rating for the practice was requires improvement with requires improvement ratings in safe and well-led services. The full comprehensive report on the February 2016 inspection can be found by selecting the ‘all reports’ link for Enki Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced comprehensive follow up inspection carried out on 25 October 2017 to confirm that the practice had carried out their plan to meet the required improvements in relation to the breaches in regulations that we identified in our previous inspection on 11 February 2016. This report covers our findings in relation to those requirements and additional improvements made since our last inspection. Overall, the practice is now rated as good.

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

  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events.
  • The practice had clearly defined and embedded systems to minimise risks to patient safety.
  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Results from the national GP patient survey showed patients were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients we spoke with said they found it easy to make an appointment with a named GP 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.
  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour. Examples we reviewed showed the practice complied with these requirements.
  • The practice had tailored their services to meet the needs of its patient population.
  • The practice had 140 substance misuse patients on their register, staff we spoke with were passionate about caring for this patient group.

The areas where the provider should make improvement are:

  • Consider how patients are informed regarding the availability of weekend appointments.

  • Ensure that lines of accountability are clear to ensure that policies are well governed and fully embedded at the practice.

  • Consider formalising the clinical supervision arrangements for the nursing team.

  • Continue to explore and work on ways to improve telephone access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 November 2017

At our previous inspection on 11 February 2016 we rated the practice as requires improvement for providing safe services as the arrangements in respect of cleanliness and infection control, recruitment checks and medicines management were not adequate.

These arrangements had significantly improved when we undertook a follow up inspection on 25 October 2017. The practice is now rated as good for providing safe services.

  • The practice had a system for reporting and recording significant events; lessons were shared to make sure action was taken to improve safety in the practice.

  • When things went wrong patients were informed as soon as practicable, received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • The practice had clearly defined systems, processes and practices to minimise risks to patient safety.

  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 15 November 2017

At our previous inspection on 11 February 2016 we rated the practice as good for providing effective services. Following this inspection on 25 October 2017, the practice is still rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were similar to or above average when compared to the national average.

  • Staff were aware of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • There was evidence of appraisals and personal development plans for all staff.

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

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 15 November 2017

At our previous inspection on 11 February 2016 we rated the practice as good for providing caring services. Following this inspection on 25 October 2017, the practice is still rated as good for providing caring services.

  • Data from the national GP patient survey showed the practice had similar satisfaction scores on consultations with GPs and nurses as compared with the CCG and national average.

  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

  • Patients told us they were proud of the practice, staff listened to them and took the time to explain things.

  • Information for patients about the services available was accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 15 November 2017

At our previous inspection on 11 February 2016 we rated the practice as good for providing responsive services. Following this inspection on 25 October 2017, the practice is still rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population. It had a lead GP and advanced nurse practitioner for substance misuse. It offered specific appointments with interpreters and employed staff who could speak multiple languages.

  • Patients we spoke with said they were able to make an appointment with a clinician of their choice, there was continuity of care and we saw urgent appointments were available on 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 evidence from two examples reviewed showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other practices within the wider organisation.

  • The practice had not updated their website to show when weekend appointments were available.

Well-led

Good

Updated 15 November 2017

At our previous inspection on 11 February 2016 we rated the practice as requires improvement for providing well-led services as risks relating to infection prevention and control, recruitment and medicines management were not always being assessed and managed. These arrangements had significantly improved when we undertook a follow up inspection on 25 October 2017. The practice is now rated as good for providing well-led services.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients.

  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.

  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour. In the examples we reviewed we saw evidence the practice complied with these requirements.
  • The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.

  • The practice proactively sought feedback from patients and we saw examples where feedback had been acted on.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas to ensure that staff had protected learning time.

  • GPs who were skilled in specialist areas used their expertise to offer additional services to patients.

  • Staff had defined roles. However, we found that in some areas lines of accountability were not always clear. For example, it was not clear who was responsible for ensuring that policies were current, embedded and practice specific.

Checks on specific services

People with long term conditions

Good

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of people with long-term conditions.

  • Nursing staff had lead roles in long-term disease management.

  • Data from 2016 to 2017 showed 83% of patients with diabetes, on the register, had a blood sugar reading that showed their condition was being adequately controlled. This was similar to the CCG and national average of 79%.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • The practice had dedicated teams to aid continuity of care including a named GP for these patients and there was a system to recall patients for a structured annual review to check 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.

  • Patients with a long term condition were also sign posted to smoking cessation, health trainers, alcohol and drug services and route 2 wellbeing services.

  • The practice maintained a Palliative Care register, which helped identify the more seriously ill patients. All seriously ill patients were discussed amongst the clinicians on a regular basis including daily team meetings once the morning appointments had finished .

  • The practice offered access to Cardiology, Rheumatology, Dermatology and Gynaecology services at the practice or at other local practices within the wider organisation.

Families, children and young people

Good

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of families, children and young people.

  • We found there were systems to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked with health visitors and school nurses to support this population group. For example, in the provision of child health surveillance clinics.

  • The practice had good baby changing and breast feeding facilities.

  • Unverified data from the practice showed the practice’s uptake for the cervical screening programme was 84%.

Older people

Good

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of older people.

  • All older patients had a named GP.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice worked with an outside support organisation to help patients with various issues such as improving mobility in and around the home.

  • Where older patients had complex needs, including those at risk of falls, the practice discussed patients in multidisciplinary meetings.

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

  • The practice provided ECGs and 24 hour blood pressure monitoring at the practice, this meant patients did not need to go to the hospital for these services.

Working age people (including those recently retired and students)

Good

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of working age people (including those recently retired and students).

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care. For example, extended opening hours on a Thursday and Saturday and Sunday appointments most weekends.

  • The practice also offered telephone consultations for those patients unable to come into the practice for an appointment because of work commitments.

  • Patients were able to book appointments in advance online with a clinician of their choice.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of people experiencing poor mental health (including people with dementia).

  • Data for 2016 to 2017 showed 75% of patients diagnosed with dementia, had their care reviewed in a face to face meeting in the last 12 months.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.

  • Data for 2016 to 2017 showed 90% of patients registered with the practice, who are diagnosed with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive care plan documented in the record, in the preceding 12 months, agreed between individuals, their family and/or carers as appropriate.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were actively identified and offered assessments.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • Staff we spoke with had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 15 November 2017

When we inspected in February 2016, the practice was rated as requires improvement for safe and well-led services. The concerns which led to these ratings applied to everyone using the practice, including this population group.

Following this inspection on 25 October 2017, the practice is now rated as good for the care of people who circumstances may make them vulnerable.

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability or mental health condition.

  • End of life care was delivered in a coordinated way, which took into account the needs of those whose circumstances may make them vulnerable.

  • The practice offered longer appointments and annual reviews for its vulnerable patients.

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff we spoke with knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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 had 140 substance misuse patients on their register. They worked closely with three drug workers through a shared care agreement to provide services for these patients.

  • The practice also registered patients who had previously been removed from other practices’ lists; this service was part of the practice’s Zero Tolerance service

  • The practice was a Safe Place site for anyone who was in need of assistance. For example Dementia patients or patients suffering domestic violence.