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Mickleover Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 5 February 2018

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Mickleover Medical Centre on 30 August 2017. 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, recording and investigating significant events. We saw evidence of applied learning relating to these events.

  • Risks to patients were assessed and monitored on an on-going basis. This included infection control and staffing levels.

  • The practice had clearly defined and embedded systems in place to safeguard children and vulnerable adults.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge, and experience to deliver effective care and treatment.

  • The practice used clinical audit to drive quality improvement within the practice.

  • The practice worked effectively with the wider multi-disciplinary team to plan and deliver effective and responsive care for patients with complex care needs.

  • Feedback from patients about their care and interactions with staff was very positive. Patients said they were treated with compassion, dignity, and respect and they were involved in their care and decisions about their treatment.

  • The majority of patients said they could usually get an appointment when they needed one, with further improvements suggested. The practice continually sought to improve access for patients and systems were in place to monitor the demand for appointments.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns.

  • The practice had a clear vision, which had quality and safety as its top priority. The strategy to deliver this vision was regularly reviewed and discussed with most staff.

  • There was a clear leadership structure and staff felt supported by management.

However there were areas of practice where the provider should make improvements:

  • Continue to ensure effective systems are in place to review, monitor and act upon patient experience data to continually drive service improvement. This includes access to the service.

  • Improve access to health checks for people with learning disabilities.

  • Embed identified improvements to ensure good communication across all staffing groups.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 February 2018

The practice is rated as good for providing safe services.

  • The practice had an effective system for reporting and recording significant events. Learning was based on a thorough analysis and investigation of significant events. Most staff told us lessons were shared to ensure appropriate action was taken to improve safety within the practice.
  • When there were unintended or unexpected safety incidents, people received an apology, support and were told about any actions to improve processes to prevent the same thing happening again.
  • Safeguarding arrangements were comprehensive, well embedded and recognised as the responsibility of all staff.
  • Medicines including vaccines were stored safely with good systems in place to monitor and control stock levels.
  • Risks to patients were well assessed and managed within the practice. Procedures for fire safety and infection control were effective with remedial action taken promptly after our inspection.
  • The practice had effective systems in place to deal with medical emergencies.
  • The practice had experienced significant staff turnover since our last inspection in 2015, and this had affected service provision. However, staffing levels had recently been improved following the recruitment of new staff and use of locum GPs. Appropriate recruitment checks had been carried out on recently recruited staff.

Effective

Good

Updated 5 February 2018

The practice is rated as good for providing effective services.

  • Systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence guidelines and locally agreed guidelines.

  • We saw evidence to confirm that the practice used these guidelines to improve practice and outcomes for patients.

  • Published data from the Quality and Outcomes Framework showed the practice was performing highly when compared to practices nationally. The practice had an overall achievement of 100% compared to a local average of 98% and the national average of 96%. High exception reporting rates were reviewed to ensure they were appropriate.

  • Clinical audits were used to review practice performance and enhance patient outcomes.

  • Multi-disciplinary working was taking place with other health care professionals to ensure patients with complex needs including those with life-limiting progressive conditions, were supported to receive coordinated care.

  • Staff had the skills and knowledge to deliver effective care and treatment. A system was in place to support staff with training, supervision and annual appraisals.

  • Patients were offered health promotion advice, health reviews and screening checks to enable them to live healthier lives.

Caring

Good

Updated 5 February 2018

The practice is rated as good for providing caring services.

  • Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this. For example, staff went the extra mile by facilitating “coffee and chat” sessions to enable patients to meet socially on a Saturday morning at the practice. The sessions were held every six to eight weeks and used to promote patient education with external guests being invited. This outstanding feature was identified at our previous inspection and staff had continued with the activities. Patient feedback was also consistently positive about the impact it had on their wellbeing and promoting social stimulation.

  • Patients we spoke with and comments cards received showed that people were treated with compassion, dignity, and respect. They felt involved in decisions about their care and treatment.

  • The national GP patient survey results showed patients rated the practice in line with or marginally lower than others for some aspects of care. For example, 82% of patients said the last GP they spoke to was good at treating them with care and concern compared to the local and national averages of 86%.

  • The practice was proactive in providing care for carers and had identified 3% of its patients as carers. The practice team and attached care coordinator were proactive in providing information and personalised support for each carer.

  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 5 February 2018

The practice is rated as good for providing responsive services.

  • The practice reviewed the needs of the local population and delivered services to meet their needs. This included chronic disease management, online services and extended opening hours in the evening and on a Saturday morning.
  • Regular ward rounds were carried out in local care homes by a named GP to ensure patients were reviewed on a regular basis.
  • Patients we spoke with and comment cards received highlighted people could access appointments and services in a way and at a time, that suits them on most occasions. Some patients felt further improvements were required in respect of telephone access and the availability of routine appointments.
  • At the time of inspection, the practice demonstrated systems were in place to proactively review and embed improvements made to telephone access and the appointment system. Improvements made included installing a new telephone system and the use of a triage system. The outcomes of these improvements had not yet been audited.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Patients could access information about how to complain in a format they could understand. Learning from complaints was shared with staff and the patient participation group.

Well-led

Good

Updated 5 February 2018

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

  • The practice team was committed to the delivery of high quality care and promoting good outcomes for their patients.

  • A mission statement and a business development plan supported the practice’s vision.

  • Policies and procedures were in place to govern activity and regular management meetings were held to review the practice’s performance.

  • 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.

  • There was a clear leadership structure which had been strengthened and senior staff had key areas of responsibility.

  • Most staff felt well supported and valued by the management team. A whole practice communication pathway had been developed in response to staff feedback.

  • The practice had a very engaged patient participation group, which influenced practice development within the practice and locality.

  • There was a focus on continuous learning and development with staff being encouraged to undertake additional training and to develop their roles.

Checks on specific services

People with long term conditions

Good

Updated 5 February 2018

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

  • The practice nurses had lead roles in long-term disease management and were able to offer expert advice and support. This included prescribing of specific medicines, monitoring of patients with diabetes and the initiation of insulin treatment within the practice.

  • Nationally reported data for most of the clinical indicators related to long term conditions were above local and national averages. For example, performance for diabetes related indicators was 100% compared to the local average of 95% and the national average of 91%.

  • An effective system was in place to recall patients for a structured annual review to check their health and medicines needs were being met. The review was also used to promote patient education and self-care on the management of their condition.

  • Patients with complex health needs and at risk of hospital admission were identified as a priority. The practice team worked closely with relevant health and care professionals including the attached care coordinator to deliver a multidisciplinary package of care.

  • Staff followed up patients discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were processes in place to facilitate urgent care and treatment for patients who experienced a sudden deterioration in health.

  • Patients could book longer appointments if they wished to be seen for multiple conditions or had complex health issues to discuss. Home visits were also offered for patients that were unable or had difficulties attending the practice.

Families, children and young people

Good

Updated 5 February 2018

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

  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

  • Children living in disadvantaged circumstances, at risk of abuse or deteriorating health were regularly discussed and monitored at monthly safeguarding meetings held with the health visitor.

  • The practice team had established communication links to promote joint working with midwives, health visitors and school nurses. This included child health surveillance clinics and the provision of antenatal and post-natal care.

  • The practice offered adolescent vaccinations and immunisation rates were relatively high for most of the standard childhood immunisations.

  • A flexible appointment system including the use of telephone triage was utilised to ensure children could be seen on the same day when this was indicated. Appointments were also available outside of school hours.

  • The practice had emergency processes for acutely ill children and young people, as well as processes for monitoring patients presenting at accident and emergency (A&E) services.

  • The premises were suitable for children and babies. Baby changing facilities were available and the practice accommodated mothers who wished to breastfeed.

Older people

Good

Updated 5 February 2018

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

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

  • Every patient over the age of 75 years had a named GP.

  • Regular multi-disciplinary meetings were held to review frail patients and those at risk of hospital admission to ensure the delivery of integrated care to meet their needs.

  • The nationally reported data showed most of the patient outcomes for conditions commonly found in older people, including osteoporosis and heart failure were above local and national averages.

  • Influenza and shingles vaccinations were offered in accordance with national guidance.

  • The practice was proactive in identifying older people who may need palliative care as they were approaching their end of life and involved them in decisions about their care.

  • The practice accommodated the needs of older patients by offering home visits, longer appointments and urgent appointments for those who needed them.

  • A named GP carried out care home visits for regular monitoring of patients identified by staff as requiring an appointment/review.

Working age people (including those recently retired and students)

Good

Updated 5 February 2018

The practice is rated as good for the care of working-age people (including those recently retired and students).

  • The practice had adjusted the services it offered to ensure these were accessible and flexible. This included access to telephone appointments as well as evening and Saturday morning appointments. Evening appointments were available between 6.30pm and 8pm at least two days a week.
  • The practice was proactive in offering online services, which included appointment booking, prescription services, access to summary care records and coded patient records.
  • A range of health promotion and screening services were offered and promoted. For example, the practice’s uptake rates for cervical, breast and bowel cancer screening were above the local and national averages.
  • The practice provided travel vaccinations and was a registered yellow fever centre.
  • A range of services were offered at the practice including minor surgery and joint injections.
  • A virtual patient participation group was in place to accommodate the views of patients who could not attend the face to face meetings.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 February 2018

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

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

  • Published data showed 96% of patients with a mental health condition had a documented care plan in the preceding 12 months compared to the local average of 92% and national average of 90%.

  • The practice told patients experiencing poor mental health about how to access services including talking therapies, various support groups and voluntary organisations.

  • The practice had a system in place for monitoring repeat prescribing for patients receiving medicines for mental health needs as well as following up patients who had attended accident and emergency where they may have been experiencing poor mental health.

  • The practice considered the physical health needs of patients with poor mental health and dementia.

  • Published data showed 73% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the preceding 12 months, which was below the local and national averages of 84%.

  • Patients at risk of dementia were identified and offered an assessment.

  • Advance care planning was incorporated in the reviews for patients with dementia.

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

People whose circumstances may make them vulnerable

Good

Updated 5 February 2018

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • Staff went the extra mile by facilitating “coffee and chat” sessions to enable patients to meet socially on a Saturday morning at the practice. The sessions were held every six to eight weeks and used to promote patient education with external guests being invited. This outstanding feature has consistently been facilitated since our last inspection in 2015. Patient feedback was also consistently positive about the impact it had on their wellbeing and promoting social stimulation.

  • The practice worked with multi-disciplinary teams including the attached care coordinator, in the case management of vulnerable people and informed patients how to access various support groups and voluntary organisations.

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

  • The practice held a register of patients living in vulnerable circumstances including informal carers and those with a learning disability. Records reviewed showed 25% of patients with a learning disability had received an annual review in the last 12 months.

  • Staff interviewed knew how to recognise signs of abuse in 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.

  • A hearing loop and translation services were available.