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Herschel Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 13 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Herschel Medical Centre on 23 November 2016. We carried out this inspection to check that the practice was meeting the regulations and to consider whether sufficient improvements had been made.

Our previous inspection in May 2016 found breaches of regulations relating to the safe, effective and responsive delivery of services. There were also concerns and regulatory breaches relating to the governance and leadership of the practice, specifically in the well led domain. The overall rating of the practice in May 2016 was requires improvement. Specifically, the practice was rated require improvement for provision of safe, effective, responsive and well-led services in May 2016. It was good for providing caring service. Following the inspection, we received an action plan which set out what actions the practice would take to achieve compliance.

At the inspection in November 2016, we found the practice had made improvements since our last inspection in May 2016. Overall the practice is rated as good. Specifically, we found the practice good for providing safe, effective, caring, responsive and well led services.

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.
  • Data showed the practice had demonstrated improvements in patient’s outcomes. Audits had been carried out and we saw evidence that audits were driving improvement in patient outcomes.
  • 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.
  • The patients we spoke with on the day of inspection informed us they had noticed improvements in the availability of appointments.
  • 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:

  • Continue to review and improve the waiting time it takes to get through to the practice by telephone.
  • Review and monitor the system in place to continue encouraging the uptake for the bowel screening programme.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 13 January 2017

The practice is rated as good for providing safe services.

  • Following our previous inspection in May 2016 the practice had made improvements in areas relating to the national patient safety and medicines alerts, staffing levels and staff had received relevant role specific training in safeguarding adults and infection control. The practice had reviewed the processes already in place to check medicines in GPs home visit bags to ensure medicines were within their expiry dates.
  • At the inspection in November 2016, there was an effective system in place for reporting and recording significant events
  • Lessons were learnt from significant events and staff we spoke with informed us that significant events were discussed during the practice team meetings. We saw evidence that lessons were communicated widely to support improvement including sharing with other local practices.
  • 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 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 13 January 2017

The practice is rated as good for providing effective services.

  • Following our previous inspection in May 2016 the practice had made significant improvements in areas relating to the medicine reviews for patients with long term conditions and all staff had received role specific training. Data showed patients’ outcomes had improved for patients with hypertension, diabetes, learning disabilities and patients experiencing poor mental health.
  • At the inspection in November 2016, we noted during the current Quality and Outcomes Framework (QOF) year 2016-17, the practice had demonstrated improvements in patient’s outcomes. For example, the practice had achieved 24 (92%) of the total number of 26 points available, for hypertension related indicators during current QOF year.
  • Staff assessed 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.
  • The practice’s uptake of the bowel screening programme was above the local average and below the national average. The practice had taken steps to encourage the uptake. However, recent data was not available to assess the improvement.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 13 January 2017

The practice is rated as good for providing caring services.

  • Following our previous inspection in May 2016 provision of caring services was rated good.
  • At the inspection in November 2016, data showed that patient outcomes were comparable to the CCG average and the national average. For example, 87% of patients said the GP was good at listening to them compared to the CCG average of 84% and national average of 89%.
  • 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.

Responsive

Good

Updated 13 January 2017

The practice is rated as good for providing responsive services.

  • When we inspected the practice in May 2016, patients said they found it difficult to make an appointment with a named GP and had to wait a long time to get through to the practice by telephone.
  • At the inspection in November 2016, we found the practice had made improvements in areas relating to access to the service. However, the practice was required to review and improve the waiting time it takes to get through to the practice by telephone.
  • The patients we spoke with on the day of inspection informed us they had noticed improvements in the availability of appointments.
  • 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. For example, two clinical pharmacists were employed to carry out medicines reviews for patients with complex needs and patients with long term conditions, which had reduced workload on GPs and improved patients outcomes.
  • 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 13 January 2017

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

  • Following our previous inspection in May 2016 the practice had made improvements in governance and monitoring of safety alerts, staffing levels and medicine reviews for patients with long term conditions.
  • At the inspection in November 2016, we found 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 a good 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 proactively sought feedback from staff, which it acted on. The patient participation group was active. However, the practice had not collected patients’ feedback through internal surveys.
  • 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
  • There was a focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 13 January 2017

The practice is rated as good for the care of patients 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 the practice carried out a structured annual review to check that their health and medicines needs were being met.
  • Data showed the practice had demonstrated improvements in patient’s outcomes. For example, the practice had undertaken 88% (on average) structured annual medicine reviews for patients with long term conditions (e.g. Diabetes, asthma, chronic obstructive pulmonary disease, chronic heart disease and dementia), which was 57% when we inspected the practice in May 2016.
  • The practice had recruited two new clinical pharmacists to carry out medicines reviews for complex cases patients with long term conditions.
  • 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 13 January 2017

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 83%, which was above the national average of 82%.

  • The practice offered Saturday morning clinics for women who found it difficult to attend for their cervical screening test during week days.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • We saw positive examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 13 January 2017

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.
  • There was a register to effectively support patients requiring end of life care.
  • There were good working relationships with external services such as district nurses.
  • The premises were accessible to those with limited mobility. The practice provided a low level desk at the front reception.

Working age people (including those recently retired and students)

Good

Updated 13 January 2017

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 offered extended hours appointments Monday to Friday from 7.30am to 8am at the premises. In addition, the practice offered extended hours appointments every Saturday and Sunday from (9am to 1pm) at Bharani Medical Centre (funded by Prime Minister’s Access Fund).
  • 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.
  • We noted the practice offered telephone consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 13 January 2017

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

  • Data from 2015-16 showed, performance for dementia face to face reviews was comparable to the CCG and national average. The practice had achieved 84% of the total number of points available, compared to 85% locally and 84% nationally.
  • Patients experiencing poor mental health were involved in developing their care plan and health checks.
  • 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 13 January 2017

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 people, travellers and those with a learning disability.
  • It offered annual health checks for patients with learning disabilities. Data from 2016-17 showed health checks were completed for 51 patients out of 67 patients on the learning disability register. Care plans were completed for 52 patients out of 67 patients on the learning disability register.
  • 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.