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Inspection Summary


Overall summary & rating

Good

Updated 16 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Aitune Medical Practice on 12 January 2016. A breach of legal requirements was found in that robust systems were not in place, 

to assess and control all risks relating to infection control and the premises. Also,

learning from significant events was not always shared promptly with all relevant staff to improve patient safety. Overall the practice was rated as good; in view of the above the practice was rated as requires improvement for providing safe services.

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

We undertook a desk based review on 17 August 2016 to check that the provider had completed the required actions, and now met the legal requirements. This report covers our findings in relation to the requirements. We did not visit the practice as part of this review. 

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Aitune Medical Practice on our website at www.cqc.org.uk.

This review found that the provider had taken appropriate action to meet the legal requirements.

  • The practice was rated as good for providing safe services.

  • Learning from significant events was 

    shared in a timely way to improve patient safety.

  • An infection control audit was completed on 9 March 2016, which mostly assessed the practice as compliantPlans were in place to appoint a new 

    lead nurse for infection control, with a view to

    completing a new audit and action plan by mid November 2016.

  • The health & safety policy and general risk assessments had been reviewed and updated, to ensure all risks to staff and patients had been assessed, and control measures were in place to keep people safe.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 September 2016

The practice is rated as good for providing safe services.

  • Learning from significant events was shared with relevant staff in a timely way to improve patient safety.  

  • An infection control audit was completed on 9 March 2016, which mostly assessed the practice as compliant. Plans were in place to appoint a new 

    lead nurse for infection control, whose initial actions will be to 

    complete a new audit and action plan by mid November 2016. 

  • The health & safety policy and general risk assessments had been reviewed and updated, to ensure all risks to staff and patients had been assessed, and control measures were in place to keep people safe.

  • The practice manager had sought advice and training relating to health and safety responsibilities to further their knowledge and role. 

Effective

Good

Updated 25 February 2016

The practice is rated as good for providing effective services.

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

  • Clinical audits were undertaken to drive improvement within the practice.

  • Data from the Quality and Outcomes Framework showed patient outcomes were in line with the average for the locality and compared to the national average. Practice achievement for 2014/15 was

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. We saw that a number of clinical staff had additional qualifications and special interests.

  • There was evidence of appraisals and personal development plans for some staff; however, some staff had not received an appraisal in the last 12 months.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs. The practice held fortnightly multidisciplinary team meetings and worked closely with a range of health professionals.

Caring

Good

Updated 25 February 2016

The practice is rated as good for providing caring services.

  • Data showed patients rated the practice higher than others for several of aspects of care. For example, 90% of patients said the GP was good at listening to them compared to the CCG average of 87% and national average of 89%.

  • Patients told us they were treated with care and concern by staff and their privacy and dignity was respected. Feedback from comment cards was mixed in respect of reception staff. However, GP patient survey data showed patients rated the receptionists highly.

  • The practice provided information for patients which was accessible and easy to understand.

  • We observed that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 25 February 2016

The practice is rated as good for providing responsive services.

  • 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, the practice supported the local integrated care hub which its patients could access outside of surgery hours. This aimed to reduce hospital admissions.

  • Patients said they found it easy to make urgent appointments with a GP but they sometimes experienced a wait to see a named GP.

  • 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 appropriately.

Well-led

Good

Updated 25 February 2016

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

  • The practice had a vision to deliver high quality care. Information about the practice aims were shared with patients in their statement of purpose and on the website. Staff were clear about the vision and their responsibilities in relation to this.

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

  • The practice had a wide range of policies and procedures to govern activity and held regular meetings. The newly appointed practice manager had identified some policies needed to be updated and was working to address this.

  • The partners encouraged a culture of openness and honesty and staff felt supported to raise issues and concerns.

  • The patient participation group (PPG) was an established group and they met regularly. The PPG was positive about future working with the practice. 
Checks on specific services

People with long term conditions

Good

Updated 25 February 2016

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

  • Clinical staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Patients identified as being at risk of admission to hospital were discussed at regular multidisciplinary meetings.

  • Indicators to measure the impact of the management of diabetes were comparable to local and national averages. For example, p

  • Longer appointments and home visits were available for patients who required these.

  • All these patients had a named GP and a structured annual review to check that their health and medicines needs were being met. For those people 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 25 February 2016

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

  • 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. The practice held regular meetings with relevant professionals to discuss children identified as being at risk.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • 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.

  • The practice’s uptake for the cervical screening programme was 82.3%, which was comparable to the CCG average of 84.8% and the national average of 81.8%.Appointments were available outside of school hours and the premises were suitable for children and babies. Urgent appointments were always available on the day.

  • We saw good examples of joint working with midwives, health visitors and school nurses.

Older people

Good

Updated 25 February 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older people in its population.

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

  • The practice worked effectively with the multi-disciplinary team to identify patients at risk of admission to hospital and to ensure their needs were met. Multidisciplinary meetings were held at the practice on a fortnightly basis.

  • The percentage of people aged 65 or over who received a seasonal flu vaccination was 67.8% which was comparable with the national average of 73.2%.

Working age people (including those recently retired and students)

Good

Updated 25 February 2016

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 accessible, flexible and offered continuity of care. This included access to telephone consultations.

  • The practice was proactive in offering online services and all GP appointments were offered through the online booking system

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

  • Extended hours consultations were offered on Saturday mornings to facilitate access for patients in this group.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 February 2016

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

  • 88.9% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was marginally above the CCG average of 85.3% and the national average of 84%.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

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

  • 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 25 February 2016

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 those with a learning disability.

  • It offered longer appointments for people with a learning disability in addition to offering other reasonable adjustments.

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

  • The practice told 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. 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.