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Charlton House Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 8 February 2018

Letter from the Chief Inspector of General Practice

At the previous inspection on 20 July 2017, the practice had been rated as requires improvement for being Safe and Well-led. We identified breaches of regulations and served requirement notices under regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out an announced focused inspection at Charlton House Medical Centre on 9 January 2018. The purpose of this inspection was to follow up on breaches of regulations identified at our previous inspection, and to review the actions taken by the practice. We saw that appropriate and sufficient action had been taken to comply with the requirements of the regulations.

The practice is now rated as Good overall.

The key questions are rated as:

Are services safe? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. As we have now rated the practice as good for providing safe and well-led services, this has revised the rating for the six population groups, as follows:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students) – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

At this inspection we found:

  • The practice had carried out: a fire risk assessment; infection prevention and control audit; and legionella risk assessment, and acted upon any recommendations.

  • It had re-stocked its emergency-use medicines cabinet, and instituted regular checking to ensure that all emergency medicines remained in stock and in date.

  • Staff treated patients with compassion, kindness, dignity and respect and involved them in decisions regarding their care and treatment.

  • The practice had ensured that all staff had completed all necessary training.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 8 February 2018

Effective

Good

Updated 26 September 2017

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 national average. For example, the percentage of patients diagnosed with dementia whose care plan has been reviewed in a face-to-face review in the preceding 12 months was 91% compared to the CCG average of 83% and the national average of 84%.

  • There were high rates of exception reporting for several clinical indicators, the practice were able to demonstrate improvement in these rates for the year 2016/17.

  • Staff were aware of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment.

  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 26 September 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients satisfaction was similar to the national average for several aspects of care. For example, 86% of patients said the last GP they saw was good at explaining tests and treatments compared with the clinical commission group (CCG) average of 83% and the national average of 86%.

  • Survey information we reviewed showed that patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. For example, in the 24 comment cards we received from patients who use the service.

  • Information for patients about the services available was accessible.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 26 September 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, by taking measures to screen for atrial fibrillation in older patients.

  • The practice took account of the needs and preferences of patients with life-limiting conditions, including patients with a condition other than cancer and patients living with dementia.

  • 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.

  • Information about how to complain was available and evidence from 11 examples reviewed showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 8 February 2018

Checks on specific services

People with long term conditions

Requires improvement

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • Performance for diabetes related indicators was above the CCG and national averages. For example, the percentage of patients with diabetes, on the register, in whom the last IFCCHbA1c is 64 mmol/mol or less in the preceding 12 months was 86% compared to the CCG average of 73% and the national average of 78%.

  • 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.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.

  • All these patients had a named GP and there was a system to recall patients for 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.

Families, children and young people

Requires improvement

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

  • From the sample of documented examples we reviewed we found 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.

  • Immunisation rates had improved form the previous year for all standard childhood immunisations.

  • 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. For example, children under the age of five were given same day appointments.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked with midwives, health visitors and school nurses to support this population group.

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

Older people

Requires improvement

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

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

    The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, patients aged 75 and over received same day appointments.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

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

  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible.

Working age people (including those recently retired and students)

Requires improvement

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours.

  • 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.

  • The practice offered telephone consultations should they be required as well as follow up.

  • NHS health checks offered for patients aged 40 to 74.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

  • The practice carried out advance care planning for patients living with dementia.

  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • Performance for mental health related indicators was above the CCG and national averages. For example, the percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, in the preceding 12 months was 96% compared to the CCG average of 83% and the national average of 89%.

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

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

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Requires improvement

Updated 26 September 2017

The provider was rated as requires improvement for being safe and well led. The concerns which led to these ratings apply to everyone using the practice, including this population group. However, we did find examples of good practice.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

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

  • 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff interviewed knew how to recognise signs of abuse in children, young people and 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.