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Putnoe Medical Centre Partnership Good

Inspection Summary


Overall summary & rating

Good

Updated 31 March 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Putnoe Medical Centre Partnership on 18 October 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. Opportunities for learning from internal and external incidents were maximised.
  • The practice used innovative and proactive methods to improve patient outcomes, working with other local providers to share best practice.
  • The practice had been involved in developing clinical templates for patient care which had been shared across the CCG.
  • Feedback from patients about their care was generally positive, with 90% of patients stating they had confidence and trust in the last GP they saw.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • 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 actively reviewed complaints and how they are managed and responded to, and made improvements to services as a result.
  • The practice had a clear vision which had the safe delivery of high quality services to patients as its top priority. The strategy to deliver this vision had been produced with stakeholders and was regularly reviewed and discussed with staff.
  • The provider was aware of and complied with the requirements of the duty of candour.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.

There were areas of practice where the provider should make improvements:

  • The system for recording medical alerts should ensure all actions are recorded centrally.
  • A complete log of drugs stored on the emergency trolley should be maintained and monitored.
  • Staff should be advised when the practice amends the business continuity plan.
  • Continue to encourage patients to attend cancer screening programmes.

  • The prescription management policy should include a process to deal with uncollected prescriptions and safe storage of prescription stationery.
  • The practice should continue efforts to identify and engage with those patients who are carers.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 31 March 2017

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
  • The practice had a comprehensive system to review and take action in relation to medical alerts. However, there was not a record of all actions taken in relation to alerts.
  • There was an effective system in place for reporting and recording significant events.
  • Lessons learnt were shared to make sure action was taken to improve safety in the practice.
  • When things went wrong patients received appropriate support, information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The policy outlining how to deal with prescription management did not include a process for uncollected prescriptions and safe storage of prescription stationery.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.
  • The practice has a business continuity plan in place for major incidents, however, when assessed the plan had not been updated and agreed amendments had not been formally recorded

Effective

Good

Updated 31 March 2017

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.
  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average or comparable with local and national average. For example, the number of patients with diabetes on the register whose last measured total cholesterol (measured within the preceding 12 months) is 5mmol/l or less was 87%. This compared well to the local CCG average of 82% and the national average of 80%.
  • 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.
  • Practice staff had been involved in the development of IT templates which had been shared with other practices in the locality by the local CCG.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 31 March 2017

The practice is rated as good for providing caring services.

  • Feedback from patients about their care and treatment was consistently positive.

  • We observed a strong patient-centred culture. Staff were motivated and inspired to offer kind and compassionate care and worked to overcome obstacles to achieving this.
  • Views of external stakeholders were positive and aligned with our findings.

  • Data from the national GP patient survey published July 2016 showed patients rated the practice higher than local and national averages for most aspects of care. For example 88% of patients described the overall experience of this GP practice as good compared to the CCG average of 86% and the national average of 85%.
  • 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.
  • The practice had identified 85 patients who were carers; approximately 0.7% of the total practice list. The practice were aware of the low numbers and were working towards identification of additional carers.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 31 March 2017

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.
  • Patients can access appointments and services in a way and at a time that suits them, with appointments available from 8.30am until 6.30pm. The GP Patient Survey results from July 2016 identified that 74% of patients were able to get an appointment to see or speak to someone the last time they tried compared to the CCG average of 77% and the national average of 76%.
  • The practice had good facilities and was well equipped to treat patients and meet their needs including those with a disability and families with children.
  • Information about how to complain was available and easy to understand, and the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 31 March 2017

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

  • The practice had a clear vision 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 management.
  • The practice had a number of policies and procedures to govern activity and held regular governance meetings.
  • There was a governance framework which supported the delivery of good quality care. This included arrangements to monitor and improve quality and identify risk. However, the practice should consider the benefits of producing a business plan, to assist with strategic management and practice development.
  • The provider was aware of and complied with the requirements of the duty of candour. The GP 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 and shared learning took place.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • There was a clear focus on continuous learning and improvement at all levels.
  • There was a high level of engagement with staff and a high level of staff satisfaction.
  • The practice gathered feedback from patients, and it had a patient participation group which influenced practice development.
Checks on specific services

People with long term conditions

Good

Updated 31 March 2017

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.
  • 97% of the patients on the diabetes register had been referred to a structured education programme in the preceding 12 months (1 April 2015 to 31 March 2016) compared to local CCG average of 93% and national average of 92%.
  • Effective arrangements were in place to ensure patients with long term conditions including diabetes, were regularly invited for a review of their condition.
  • 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.
  • The practice held a Gold Standard Framework (GSF) palliative care register, where all patients have a named GP. Patients were discussed with other health care professionals, including Macmillan and community nurses at monthly meetings.

Families, children and young people

Good

Updated 31 March 2017

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 comparable to local and national averages for 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.
  • 74% of women aged between 25 - 64 years of age whose notes record that a cervical screening test has been performed in the preceding five years, was in line with the local CCG average of 76% and the national average of 74%.
  • 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.
  • Clinics were provided on site for children’s services, including health visitor, speech therapist and post-natal well-being for mothers.

Older people

Good

Updated 31 March 2017

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 for patients unable to travel and urgent appointments for those with enhanced needs.
  • At the time of our inspection, the practice had 83 patients who were living in 17 care homes across the area. GPs undertook weekly visits to one home where 23 patients resided. Residents in other care homes were provided with the services as they were required.
  • All of these patients are offered an annual review of their care needs.
  • A coffee morning had been established to enable elderly patients and local residents to combat loneliness and social exclusion.

Working age people (including those recently retired and students)

Good

Updated 31 March 2017

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.
  • Data showed 58% of patients aged 60 to 69 years had been screened for bowel cancer in the last 30 months compared to 59% locally and 58% nationally.
  • Data showed 57% of female patients aged 50 to 70 years had been screened for breast cancer in the last three years compared to 74% locally and 72% nationally.
  • 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.
  • Appointments had been made available during lunchtimes, for those patients not able to attend at other times during normal working hours. Telephone consultations were also available.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 March 2017

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

  • 86% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which matched the local average and was higher than the national average of 84%.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended A&E where they may have been experiencing poor mental health.
  • Clinics were available on site with a nurse trained in supporting Parkinsons Disease.
  • Staff had received dementia friends training and demonstrated a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 31 March 2017

The practice is rated as outstanding 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, travellers and those with a learning disability.
  • 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 informed vulnerable patients about how to access support groups and voluntary organisations.
  • A dedicated patient support team was able to arrange transport for patients with mobility concerns.
  • The practice acted as a food bank voucher issuing centre for those patients considered to be at most risk.
  • 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’s computer system alerted GPs if a patient was also a carer. The practice had identified 85 patients (0.7% of the total practice list) as carers and 238 patients (approximately 2%) identified as being cared for.
  • The practice worked closely with the Bedfordshire Carers Group, for example the group recently attended a ‘patient open evening’ to provide information of support available