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Inspection Summary


Overall summary & rating

Good

Updated 4 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Morden Hall Medical Centre on 5 November 2015. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

  • The practice operated an open and transparent approach to safety and had effective systems in place for reporting and recording significant events.
  • Risks to patients were assessed and managed.
  • 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.
  • Patients said they were treated with kindness and compassion, their privacy and dignity was respected and they were involved in their care and decisions about their treatment.
  • Information about the services provided including how to complain was available and easy to understand.
  • Patient’s we spoke with had mixed experience of making an appointment with some finding it easy and others experiencing a wait. Urgent appointments were available the same day.
  • The practice had good facilities and was equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by the partners and management.
  • The practice sought feedback from patients and staff, which it acted on.
  • The provider was aware of and complied with the requirements of the Duty of Candour.

The areas where the provider should make improvement are:

  • Develop systems to monitor the use of prescription pads.

  • Ensure recruitment practice includes two written references being sought with gaps in employment explored.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 4 February 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and one of the GPs was the lead.

  • Lessons were shared to make sure action was taken to improve safety within the practice.

  • When there are unintended or unexpected safety incidents, people received reasonable support, were told about any actions to improve and received a verbal or written apology.

  • The practice had clear policies, processes and practices in place to keep people safe and safeguarded from abuse, staff completed training and were clear about their responsibilities to report concerns.

  • Risks to patients were assessed and well managed.

  • While staff recruitment practices were in line with requirements records were kept in a number of different places making it difficult to ensure the required checks had been completed for all staff.

Effective

Good

Updated 4 February 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.

  • 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.

  • Staff had access to appropriate training and all staff had an annual appraisal.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 4 February 2016

The practice is rated as good for providing caring services.

  • While data showed that patients rated the practice lower than others for several aspects of care the practice was working with their Patient Participation Group and patients to improve the patient experience. Although this had not been reviewed, feedback we received indicated patients were experiencing improvements.

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

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

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

Responsive

Good

Updated 4 February 2016

The practice is rated as good for providing responsive services.

  • They reviewed the needs of the local population and engaged with the NHS England Area Team and Clinical Commissioning Group to identify improvements and worked to make the required changes. Staff spoke a number of the languages of the local population.

  • Patients reported mixed experiences of making appointments although feedback was indicating improvements, urgent appointments were 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. Evidence showed the practice responded quickly and appropriately to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 4 February 2016

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

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

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

  • There was a clear governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • 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 knowing about notifiable safety incidents.

  • The practice sought and responded to feedback from patients and staff. There was an active patient participation group who were involved in the practice development and felt listened to.

  • There was a strong focus on learning and improvement.

Checks on specific services

People with long term conditions

Good

Updated 4 February 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.

  • Nationally reported data showed outcomes for patients with diabetes was in line with national averages.

  • They provided longer appointments and home visits when needed.

  • All these patients had a structured annual review to check that their care and treatment plans remained appropriate.

  • They worked with other health and care professionals to deliver multidisciplinary care.

  • They provided these patients with an alternative contact number to enable fast access to the practice.

Families, children and young people

Good

Updated 4 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. One of the GPs was the safeguarding lead.

  • Immunisation rates were in line or above local and national averages for all standard childhood immunisations.

  • Data showed the rates for cervical smears were in line with national averages.

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

  • The practice worked with midwives and health visitors.

Older people

Good

Updated 4 February 2016

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

  • The practice provided a named GP for patients over 75 years of age.

  • They offered proactive, personalised care to meet the needs of older patients.

  • Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

  • They provided a range of enhanced services including working with patients to prevent unplanned admissions.

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

  • They worked with other health and social care professionals to provide joined up care.

Working age people (including those recently retired and students)

Good

Updated 4 February 2016

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

  • The age profile of patients at the practice contains those of working age, students and the recently retired, services available were largely reflective of the needs of this group. The practice offered online services as well as a full range of health promotion and screening that reflected the needs for this age group. The practice offered extended opening hours for appointments on Mondays from 6.30-9pm.

  • The practice had recently launched a twitter feed in order to engage more effectively with this demographic.

People experiencing poor mental health (including people with dementia)

Good

Updated 4 February 2016

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

  • 78% of people diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months.

  • One of the nurses was a dementia specialist nurse.

  • Nationally reported data identified outcomes for patients experiencing poor mental health were above local and national averages.

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

  • They 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 and a counselling service was provided at the practice.

  • There were systems in place to follow up patients who had attended accident and emergency departments where they may have been experiencing poor mental health.

  • Staff demonstrated a good understanding of how to support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 4 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 homeless people and those with a learning disability.

  • They offered longer appointments for people with a learning disability and 33% of these patients had received an annual review of their health needs so far this year. All had an annual review last year.

  • One of the nurses completed additional training in how to meet the health needs of patients with learning disabilities.

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

  • It had told vulnerable patients about how to access various support groups and voluntary organisations.

  • Staff knew how to recognise signs of abuse in vulnerable adults. 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.

  • They had access to telephone and on line translation services and staff spoke a number of the languages of the local population.

  • The patient record identified if a patient was a carer and staff signposted to relevant local support services.