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Inspection Summary


Overall summary & rating

Good

Updated 28 October 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Hollybrook Medical Centre on 26 January 2016. During that inspection we found that a robust system was not in place to check the expiry dates of medicines carried by GPs on home visits. Also, a risk assessment had not been completed for certain non-clinical staff who undertook chaperone duties, who had not received a disclosure and barring service check.

Overall the practice was rated as good with are services safe requiring improvement in view of the above.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 

Hollybrook Medical Centre 

on our website at www.cqc.org.uk.

After the comprehensive inspection, the practice told us what action they had, and were taking to meet the legal requirement in relation to the breach.

We undertook a focused inspection on 22 September 2016 to check that the provider had completed the required action, and now met the legal requirements. 

We visited the practice as part of this inspection. 

This report covers our findings in relation to the requirement. 

This inspection found that the provider had taken appropriate action to meet the legal requirement.

  • An effective system was in place to check the expiry dates of medicines carried by GPs on home visits to ensure they were in date and appropriate to use.

  • All staff carrying out chaperone duties had received a disclosure and barring service check. (These 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 vulnerable children or adults).

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 October 2016

  • The practice is rated as good for safe.
  • An effective system was in place to check the expiry dates of medicines carried by GPs on home visits to ensure they were in date and appropriate to use.
  • Policies had been updated to require that all new and long-standing staff have received a disclosure and barring service check (DBS).
  • Records showed that all staff carrying out chaperone duties had received a satisfactory DBS check. 

Effective

Good

Updated 14 March 2016

The practice is rated as good for providing effective services.

Systems were in place to ensure that all clinicians were up to date with National Institute for Health and Care Excellence (NICE) and other locally agreed guidelines, and clinicians used these as part of their work.

Regular audits were undertaken and improvements were made as a result to enhance patient care. However audits had not been repeated to reflect that improvements had been maintained.

Processes were regularly reviewed and improvements made. For example; SMS messaging was implemented to remind patients about their appointment which had reduced the number of patients who failed to turn up for their appointments.

Staff had received training appropriate to their roles and any further training needs had been identified and appropriate training planned to meet these needs. There was evidence of appraisals and personal development plans for all staff.

Staff worked closely with multidisciplinary teams to plan, monitor and deliver appropriate care for patients. The teams included midwives, health visitors, community matron, district nurses and the mental health team

Caring

Good

Updated 14 March 2016

The practice is rated as good for providing caring services.

Data from the national GP patient survey published in July 2015 showed that patients rated the practice higher than others for several aspects of care. For example; 91% of patients said their GP was good at treating them with care and concern, compared with the national average which was 85%

Patient survey data indicated patients considered they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment For example; 87% of patients said that their GP involved them enough in decisions about their care

Information for patients about the services available was easy to understand and accessible. We also saw staff treated patients with kindness and respect, ensuring that confidentiality was maintained. 

Responsive

Good

Updated 14 March 2016

The practice is rated as good for providing responsive services.

They were aware of the practice population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.

Patients were generally satisfied with the appointment system but told us they sometimes needed to wait for a long time to see their preferred GP. Urgent appointments were available the same day. Telephone consultations and home visits were available by appointment and where required.

The practice had good facilities including a dedicated baby changing room and was well equipped to treat patients and meet their needs. The premises were suitable for patients who were disabled.

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 on the practices computer system and at meetings.

Well-led

Good

Updated 14 March 2016

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

It had a clear vision and strategy which was shared with staff who understood their responsibilities in relation to this. There was a clear leadership structure and staff felt well supported by management. High standards were promoted and owned by all practice staff and teams worked together across all roles.

The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group (PPG) was active and had influenced change within the practice through regular collaborative meetings with the practice management team.

Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities. There was a high level of constructive engagement with staff and a high level of staff satisfaction generally.

Learning and development was encouraged and supported by the partners and management team and dedicated time was assigned for clinical staff to attend development. 

Checks on specific services

People with long term conditions

Good

Updated 14 March 2016

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

The practice had a systematic and caring approach to managing long term conditions. GPs reviewed all patients with a long term condition annually and where patients had more than one long term condition, they had all of their conditions reviewed in a single appointment. Where more regular reviews were required, these were provided by the nursing staff, who had roles in chronic disease management.

The practice had a diabetic nurse specialist who regularly monitored diabetic patients at the practice so that they didn’t have to travel to receive their care.

Longer appointments and home visits were available when needed.

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.

Influenza vaccinations were offered to all patients with a LTC and these were provided in the patient’s own home for house bound patients. This enabled the practice to achieve an uptake of influenza vaccinations for 81% of patients registered as having coronary heart disease compared to the national average which was 76%.

Families, children and young people

Good

Updated 14 March 2016

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

Immunisation rates were high for all standard childhood immunisations. For example, childhood immunisation rates for the vaccinations given to two year olds ranged between 94% and 99% compared to a CCG range of between 97% and 99%

Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this. They ran dedicated influenza clinics for children during the half term holiday.

Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments were always available on the day for children under five.

The practice worked collaboratively with midwives and health visitors and provided post-natal baby checks and influenza vaccination for ladies who were pregnant.

The practice offered cervical smear tests and took this opportunity to consult regarding sexual health and contraception. Patients who did not attend were followed up to ensure they were given every opportunity to attend the clinic. They had achieved 79% attendance rate for providing smear tests for relevant patients which was in line with CCG average and national averages.

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 people who had a high number of A&E attendances. They had achieved 100% of available points for indicators relating to asthma which was 1% better than the CCG average and 3% better than the national average. There exception reporting rate across the four indicators was between 3% and 19% which was also above CCG and national averages for exception reporting.

The practice offered travel immunisations and advice for people wishing to travel abroad.

Older people

Good

Updated 14 March 2016

The practice is rated as good for the care of older people and offered proactive, personalised care to meet the needs of the older people in its population. Patients had a named GP and had written care plans that were shared with outside agencies as required. They offered home visits and urgent appointments for those with enhanced needs.

All patients over aged 75 were invited for a health check if they had not visited the practice within the last 12 months and had already achieved health checks for 69% of these patients this performance year.

The practice provided regular scheduled visits to the care homes in their locality so that care could be proactively managed and this reduced the number of urgent visits required.

The practice also has a dedicated nurse for visiting housebound patients, many of whom were elderly, as part of their Annual Care Review (ACR), and to deliver flu vaccines.

Working age people (including those recently retired and students)

Good

Updated 14 March 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). They had identified the needs of this population group and had adjusted the services they offered to ensure these were accessible, flexible and offered continuity of care. This included access to telephone appointments, and the availability of appointments throughout the day until 8pm.

The practice offered online services such as electronic prescriptions, and GP appointments were offered through the online booking system which was being proactively encouraged.

Health promotion and screening was provided that reflected the needs for this age group.

Patients were offered a choice when being referred to other services using the NHS e-referral service to take into account the most convenient location for travel.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 March 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia) and had achieved outcomes which were comparable with local and national averages. For example;

  • 77% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which is marginally below the CCG and national average (CCG average 85%, national average 84%)
  • They had achieved 100% of available points in respect of monitoring patients being treated with the drug Lithium which was 5% better than the CCG average and 9% better than the national average. The exception rate was also slightly higher at 9% to CCG and national averages (5% and 4%)

The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia and carried out advance care planning for patients who needed it.

They had told patients experiencing poor mental health about how to access various support groups and voluntary organisations and provided information about these in the waiting area.

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 14 March 2016

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

The practice worked closely with a care coordinator who monitored the attendance and discharge of patients from secondary care. Follow up appointments, including home visits if required, were booked and services from the practice and the community team made available to support patients’ rehabilitation following discharge from hospital. The care coordinator also worked collaboratively with the practice, community matron, other attached staff and community services to plan care for people with complex needs and others who needed it. Patients were also able to self-refer to the care coordinator to receive assistance with planning social care.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. Staff knew how to recognise signs of abuse in vulnerable adults and children.

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 held a register of patients living in vulnerable circumstances including those with a learning disability and offered longer appointments. They invited them for an annual health check with the nursing team who had completed training in this area. At the time of our inspection 34% of patients with a learning disability had received their annual health check. They had followed up written invitations with a telephone call to remind them of the appointment.

The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

The practice had arranged for a local organisation to attend the practice monthly to provide hearing aids and support to patients with hearing loss.