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Kirby - Crompton Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 19 December 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Kirby-Crompton Health Centre

on 1 November 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events.
  • Risks to patients were assessed and well managed.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with 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 was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns and where actions were identified these were used to improve patient outcomes. The practice used a book to record low level concerns. These concerns were investigated but details about outcomes were not formally recorded. The issues logged were not always low level concerns.
  • Patients 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.
  • All staff employed by the practice had received a disclosure and barring check (DBS check). (DBS checks identify whether a person has a criminal record or is on an official list of people barred from working in roles where they may have contact with children or adults who may be vulnerable).
  • The practice was IRIS (Identification and Referral to Improve Safety) approved and the GPs and staff were trained in domestic violence awareness.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements. 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.

Professor Steve Field CBE FRCP FFPH FRCGPChief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 December 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. The learning from significant events was linked to the Bolton quality standards to ensure ongoing improvement.
  • Lessons were shared with the staff team to make sure action was taken to improve safety in the practice.
  • When things went wrong patients 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 and embedded systems, processes and practises in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 19 December 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the CCG and national average.
  • Staff assessed patients’ needs 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.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 19 December 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Information for patients about the services available was easy to understand and accessible.
  • Feedback from patients through the CQC comment cards about their care and treatment was consistently and strongly positive. Patients said they were always treated with dignity and respect and they were involved in decisions about their care and treatment.

  • Reception staff knew when patients wanted to discuss sensitive issues or appeared distressed they could offer them a private room to discuss their needs.

Responsive

Good

Updated 19 December 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the Clinical Commissioning Group to secure improvements to services where these were identified.
  • Patients 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.
  • 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 19 December 2016

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

  • The practice had 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 it.
  • 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 provider 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 19 December 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.
  • 95% of patients with diabetes, on the register, have had an influenza immunisation in the preceding 12 months. This was comparable with the CCG and national average of 94%.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and 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 were now invited for their review in their birth month which GPs found ensured more personalised care.
  • Longer appointments were available to review multiple conditions such as dementia, mental health and rheumatology.
  • Patients with Chronic Obstructive Pulmonary Disease were offered rescue medicines in case of an emergency at home.
  • GP’s regularly reviewed diabetic patients struggling with high blood glucose levels.

Families, children and young people

Good

Updated 19 December 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 were at risk, for example, children and young patients who had a high number of A and E attendances. Immunisation rates were high for all standard childhood immunisations.
  • 85% of women aged between 25 and 64 had their notes recorded that a cervical screening test had been performed in the preceding five years which was comparable to the CCG and national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • Same day appointments were available for children.
  • We saw positive examples of joint working with midwives and health visitors.
  • All staff were trained in safeguarding.
  • Child development examinations were available with a GP.
  • Routine childhood immunisations were given by one of the practice nurses who was up to date with current vaccination schedules.
  • There was an allocated session in the primary health care team meeting to review children at risk and teenage mothers supported by the Family Nurse Partnership.

Older people

Good

Updated 19 December 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 patients in its population.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs. Telephone consultations were available with a GP or nurse.
  • All patients over 75 years had personalised care plans and a named GP.
  • Shingles, influenza and pneumococcal vaccinations were offered.
  • The building had ramps and a lift to aid patients’ mobility.
  • There was dedicated space in the waiting area for patients who used a wheelchair.

Working age people (including those recently retired and students)

Good

Updated 19 December 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 was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
  • Early morning and late evening appointments were available with GP’s and nurses.
  • NHS health checks were actively promoted.
  • The practice actively promoted meningitis vaccinations and sexual health screening.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 December 2016

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

  • 88% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months compared to the CCG average of 86% and the national average of 84%.
  • 94% of patients with schizophrenia, bipolar affective disorder and other psychoses had a comprehensive, agreed care plan documented in their record in the preceding 12 months compared to the CCG average of 90% and the national average of 88%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • A designated GP carried out advance care planning for patients with dementia and longer appointments were available.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended A and E where they may have been experiencing poor mental health.
  • 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 19 December 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 such as those with a learning disability.
  • The practice offered longer appointments for patients with a learning disability.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • 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.
  • Practice staff discussed patients at the primary health care team meeting which enabled multidisciplinary involvement.
  • Patients with a learning disability were always dealt with urgently and were included in the admission avoidance register.
  • The practice had established good links with local drugs and alcohol services which had provided staff with awareness training.