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Archived: Lancelot Medical Centre Good

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Inspection Summary


Overall summary & rating

Good

Updated 7 July 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Lancelot Medical Centre on 18 September 2015. The overall rating for the practice was requires improvement. The full comprehensive report of the 18 September 2015 inspection can be found by selecting the ‘all reports’ link for on our website at www.cqc.org.uk.

This inspection was carried out to check that action had been taken to comply with legal requirements, ensure improvements had been made and to review the practice's ratings. Overall the practice is now rated as good.

Our key findings 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.
  • Recent feedback from patients were positive. Patients said they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment. The service was accessible.
  • 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 staff and patients, which it acted on.
  • The practice had addressed the concerns identified at our previous inspection, for example, it had improved the layout of the waiting area to protect patient confidentiality.

The areas where the provider should make improvement are:

  • The practice should introduce a process to monitor that relevant safety alerts are actioned.
  • The practice should review areas of performance where its exception reporting is above average to ensure that patients are being appropriately monitored over time.
  • The practice should continue to proactively identify patients who are carers to ensure they receive appropriate support and their needs are met.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 July 2017

The practice is rated as good for providing safe services.

  • The practice had an effective system for reporting and recording significant events. Lessons were shared and action was taken to improve safety in the practice.

  • When things went wrong patients were informed, given an explanation and a written apology. Patients were told about any actions to prevent the same thing happening again.

  • The practice had clearly defined and embedded 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 7 July 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and outcomes framework showed that practice performance in managing long term conditions was above the national average.

  • Staff were aware of and used current evidence based guidance.

  • We saw evidence of clinical audit and quality improvement work with positive results.

  • 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.

  • The practice actively promoted the health of its patients through information, education and preventive programmes.

Caring

Good

Updated 7 July 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey was variable. Patients rated the practice in line with the local average for nurse consultations and involvement. However, patient ratings were somewhat lower than average for satisfaction with GP consultations and reception.

  • However, recent NHS Friends and family survey results showed that the overwhelming majority of participating patients would recommend the service to others.

  • Patients who participated in the inspection were positive about all aspects of the service. Patients told us they were treated with compassion and respect and they were involved in decisions about their care and treatment.

  • Information for patients about the services available was accessible in a range of languages. This had improved since our previous inspection.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality. The practice had made improvements to the layout of the surgery to better protect patient confidentiality since our previous inspection.

Responsive

Good

Updated 7 July 2017

The practice is 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, for example providing a shared care mental health service.

  • The practice scored below average for the accessibility of the service on the national GP patient survey. However the practice had subsequently made changes to the appointment system and recent patient feedback was positive.

  • The practice was equipped to treat patients and meet their needs.

  • Information about how to complain was available and evidence from a recent example showed the practice responded quickly to issues raised. Learning from complaints was shared with the practice team.

Well-led

Good

Updated 7 July 2017

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

  • The practice had a clear purpose, values and strategy to deliver high quality care and promote good outcomes for patients.
  • Staff were clear about their responsibilities.
  • There was a clear leadership structure. The practice had policies and procedures to govern activity and held regular governance meetings.
  • The practice had a strong safety culture and effective arrangements in place to identify and monitor risks.
  • 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. The practice had systems to notify patients of any incidents meeting the duty of candour criteria. The practice learned from incidents, accidents and alerts.
  • The practice sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with its patient participation group.
  • There was a focus on continuous learning and improvement at all levels. The practice had responded to concerns raised at our previous inspection in September 2015.
Checks on specific services

People with long term conditions

Good

Updated 7 July 2017

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

  • The practice maintained registers of patients with long-term conditions. There was a system to recall patients for a structured annual review to check their health and medicines needs were being met. The GPs and practice nurse had roles in long-term disease management.

  • The practice had performed well on the Quality and Outcomes Framework (QOF) for managing long-term conditions. The practice ran a number of chronic disease review clinics including asthma, chronic obstructive pulmonary disease (COPD) and diabetes.

  • 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 provided an extended range of diagnostic services including ECG, 24 hour blood pressure monitoring, spirometry and an in-house phlebotomy service so patients did not need to be referred elsewhere.

  • The practice provided information for patients on managing long term conditions. It displayed educational posters signposting patients to further sources of support such as Diabetes UK. The practice also held a range of patient information leaflets (in multiple languages) covering conditions including diabetes, cardiovascular, and respiratory conditions.

Families, children and young people

Good

Updated 7 July 2017

The practice is rated as good for the care of families, children and young people.

  • The practice provided antenatal and postnatal services. A midwife visited the practice once a fortnight to provide antenatal checks.

  • Immunisation rates were high for standard childhood immunisations. The practice encouraged pregnant women to have the flu and pertussis vaccinations (whooping cough).

  • Appointments were available outside of school hours and the premises were suitable for children and babies, for example with baby changing facilities.

  • The practice had emergency processes for acutely ill children and young people and for acute pregnancy complications.

  • 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.

  • The practice liaised health visitors and school nurses to support families and children, for example in following up potential safeguarding concerns. The community midwife attended the practice regularly to provide antenatal check ups and advice.

Older people

Good

Updated 7 July 2017

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

  • The practice offered personalised care to meet the needs of the older patients in its population, for example by developing integrated care plans for older patients with more complex needs.

  • The practice referred patients with the greatest health care needs to the local Complex Patient Management Group.The group's meetings were held monthly and attended by social care coordinators, social workers, district nurses, local GPs, and secondary care hospital consultants including a psychiatrist.

  • The practice was aware of the range of local community services and resources available to support older patients at home such as STARRS (the Brent short term assessment, reablement and rehabilitation service).

  • The practice also held its own monthly case management meetings with the district nursing team to review the care of vulnerable, housebound patients.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments as appropriate.

  • The practice followed up older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.

  • The practice provided preventative advice and services for older patients and carers including influenza and shingles vaccination.

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

Working age people (including those recently retired and students)

Good

Updated 7 July 2017

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 available outside of working hours.

  • The practice offered online services, telephone consultations, text messaging.

  • The practice provided a full range of health promotion and screening reflecting the needs for this age group.

  • Practice patient uptake for the cervical screening programme was above average although exception reporting was also high.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 July 2017

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

  • All 18 (100%) of patients with a diagnosed psychosis had a comprehensive care plan in their records. The practice had not reported any exceptions for this indicator. This was an area where practice performance had improved since our previous inspection in September 2015.

  • The practice worked with multi-disciplinary teams in the case management of people experiencing poor mental health.

  • The practice carried out advance care planning for patients with dementia including consideration of ‘do not resuscitate’ decisions. The practice involved patients and carers in care planning and considered carers’ needs, for example for respite care.

  • The practice was able to signpost patients experiencing poor mental health to various support groups and voluntary organisations.

  • The practice hosted a counsellor one day a week.

  • The practice had a system in place to follow up patients who had attended accident and emergency for example for self-harm or who were known to have mental health problems.

People whose circumstances may make them vulnerable

Good

Updated 7 July 2017

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 homeless people and those with a learning disability. Vulnerable patients were supported to register at the practice.

  • The practice offered longer appointments for patients with a learning disability or other complex needs.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

  • The practice informed vulnerable patients about how to access support groups and voluntary organisations, for example the local carers associations.

  • 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. The practice operated its own 'traffic light' alert system to prioritise its response to its more vulnerable patients.