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Inspection Summary


Overall summary & rating

Good

Updated 23 June 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Parkside Practice on 11 July 2016. The practice was rated good for effective, caring, responsive and well-led domains, and was rated requires improvement for the safe domain. The overall rating for the practice was good. The full comprehensive report on the July 2016 inspection can be found by selecting the ‘all reports’ link for Parkside Practice on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 31 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulations that we identified in our previous inspection on 11July 2016. This report covers our findings in relation to those requirements.

At our previous inspection on 11 July 2016, we rated the practice as requires improvement for providing safe services as the chaperone policy was not fully risk assessed by the practice. In addition, recruitment processes were lacking clearly documented evidence around records to demonstrate full former employment checks had been completed for all employees.

It was also noted on the previous inspection that the treatment room and medicines fridge were not always known to be securely locked. In addition the practice was advised that it should do more to increase support to patients with mental health needs.

Our key findings from our inspection on 31 May 2017:

  • The practice had now implemented comprehensive employment checks with relation to the employment of locum GPs and all new staff.
  • Staff had been risk assessed for chaperone duties and correctly trained.
  • There was an increase in security for medicines and confidential information.
  • Vulnerable mental health patients who were not attending for annual review (after three invitations to do so) were being personally telephoned by their named GP for welfare checks and invited again to attend the practice.
  • The practice had sought support from the local clinical commissioning group (CCG) and local medical committee (LMC) to assess and facilitate changes to the practice management. A new manager had been recruited to oversee these changes and to work with the practice to continue to improve the general management and structure of the practice.
  • The patient participation group was providing support to the patient engagement meetings facilitated by the CCG and was producing an informative quarterly newsletter for all patients.
  • The practice was proactively looking at new ways of working in the future with other local providers to improve patient care.
  • The practice was currently reviewing the appointment booking system in order to provide a greater balance between pre-bookable and open access appointments without the need to increase the staffing levels.
  • There was a targeted programme using social media to engage with younger patients and to keep them supplied with relevant health information.

The practice is now rated as good for providing safe services.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 23 June 2017

This practice is now rated as good for providing safe services.

  • All staff undertaking chaperone duties had been risk assessed and received the relevant training.
  • All practice staff understood that only clinical staff had been risk assessed to be chaperones.
  • There was clear documentation to evidence that all staff, and particularly locum staff, had the relevant employment and qualification checks in place.
  • Practice rooms had keypad entry to maintain security for all medicines and confidential materials.

Effective

Good

Updated 23 June 2017

Caring

Good

Updated 23 June 2017

Responsive

Good

Updated 23 June 2017

Well-led

Good

Updated 23 June 2017

Checks on specific services

People with long term conditions

Good

Updated 12 December 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.

  • 78% of patients with diabetes had an acceptable blood pressure reading, which was similar to the CCG average of 77% and national average of 87%.

  • Longer appointments and home visits were available when needed.

  • 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 12 December 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 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 practices uptake for the cervical screening programme was 79% which was lower than the CCG average 82% and the national average 81%.

  • 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, health visitors and school nurses.

Older people

Good

Updated 12 December 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 patients in its population.

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

  • Performance for conditions common in older people was similar to the national averages. For example 84% of patients with high blood pressure had a blood pressure reading which was in acceptable limits compared to the clinical commissioning group (CCG) average and national average Performance for conditions common in older people was similar to the national averages.

Working age people (including those recently retired and students)

Good

Updated 12 December 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 12 December 2016

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

  • 100% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is better than the national average 84%.

    57% of patients with schizophrenia, bipolar affective disorder and other psychoses who have a comprehensive, agreed care plan documented in the record, which is lower that the CCG 88% and national average of 88%.

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

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

People whose circumstances may make them vulnerable

Good

Updated 12 December 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 patients, travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • The practice had identified 25 patients with a learning disability; 72% of these had received a physical health check in the previous 12 months

    .

  • 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.