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Millrise Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 30 June 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Millrise Medical Practice on 27 July 2016. The overall rating for the practice was good with requires improvement in providing safe services. The full comprehensive report from the inspection on the 27 July 2016 can be found by selecting the ‘all reports’ link for Millrise Medical Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 22 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 27July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as good.

Our key findings were as follows:

  • The provider had developed a recorded system to receive and act on alerts about medicines that may affect patients’ safety.

  • The provider had implemented a consistent system for checking that monitoring for patients who took long term medicines on a shared care basis had been provided before issuing prescriptions.

  • An updated fire risk assessment was in place and weekly testing of the fire alarm was undertaken in line with best practice guidance.

  • The provider had improved the identification of patients who were also carers resulting in an increase to 2.4% of the practice population. There was a good range of information available to carers and they were also offered annual health checks.

  • The provider had revised their protocol for requesting home visits. The new procedure ensured that decisions about the urgency of a home visit were made by the on-call GP.

  • Complainants were made aware of the avenues of escalating their complaint within the practice’s response letters should they not be satisfied with the outcome of their complaint. However, not all patients spoken with were aware of how to make a complaint and the complaint leaflets were not readily accessible.

  • Patients commented that they were happy with the service provided. They told us that there were a range of appointments available to them and they could get an appointment when they needed one.

  • Patients felt that staff were helpful and friendly and treated them with dignity, compassion and respect.

  • The practice was actively recruiting clinical staff to fill the vacant GP positions and was open to exploring new ways of working.

However, there was still one area of practice where the provider could make improvements.

The provider should:

Make sure patients are aware of the complaint procedure and ensure complaints forms are readily available to patients.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 June 2017

  • The provider’s system to receive and act on alerts about medicines that may affect patients’ safety was effective.

  • The provider had implemented a consistent system for checking that monitoring for patients who took long term medicines on a shared care basis had been provided before issuing prescriptions.

  • The practice had updated their fire risk assessment to minimise the risks to patients in the event of a fire. Fire tests were being completed at the recommended frequency.

Effective

Good

Updated 28 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at average when compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills, knowledge and experience 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.

Caring

Good

Updated 28 September 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

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

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

  • The practice identified, and provided additional services for carers. The overall number of carers identified was 0.7% of the patient list which given that the number of older patients registered with the practice was greater than the national average, this was lower than expected.

Responsive

Good

Updated 28 September 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 offered appointments on a Saturday morning.

  • Patients 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 easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 28 September 2016

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

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.

  • There was a clear leadership structure and staff felt supported by the management. The practice had a number of policies and procedures to govern activity and held regular governance meetings.

  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty.

    The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken

  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 28 September 2016

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

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

  • Longer appointments and home visits were available when needed.

  • 98% of patients with atrial fibrillation (irregular heart rhythm) were prescribed an appropriate medicine to decrease the risk of blood clots. This was the same as the CCG and national averages.

  • All these patients had a named GP and 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

Good

Updated 28 September 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. Immunisation rates were higher than local and national levels 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 81% compared with the CCG average of 80% and national average of 82%.

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

  • We saw positive examples of joint working with midwives and health visitors.

Older people

Good

Updated 28 September 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.

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

  • The practice advanced nurse practitioner undertook weekly proactive visits to patients in a local care home in which many patients were of an older age.

Working age people (including those recently retired and students)

Good

Updated 28 September 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.

  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 September 2016

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 with dementia.

  • Performance for poor mental health indicators was better than local and national averages. For example, 91% of patients with enduring poor mental health had a recent comprehensive care plan in place compared with the CCG average of 86% and national average of 88%.

  • The practice carried out advance care planning for patients 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 28 September 2016

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

  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.

  • The practice informed 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. 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 had taken action to offer 32 patients with a learning disability annual health reviews. Training had been secured and procedures implemented to provide the checks from September 2016.