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Marine Avenue Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 16 November 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Marine Avenue Medical Centre on 15 December 2015. The overall rating for the practice was good; but was requires improvement for providing safe services.

We carried out an announced focused inspection on 24 August 2017 to review in detail the actions taken by the practice to improve the quality of care. We found action had been taken to address all of the issues identified at the previous inspection. However, we identified an additional concern in relation to the storage of medicines requiring refrigeration.

The reports on the December 2015 and the August 2017 inspections can be found by selecting the ‘all reports’ link for Marine Avenue Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 26 October 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection in August 2017. This report covers our findings in relation to those requirements.

Overall the practice is rated as good overall and now good for providing safe services.

Our key findings were as follows:

At our previous inspection on 24 August 2017 we said the provider should ensure appropriate arrangements are in place to maintain the cold chain for medicines requiring refrigeration. During this inspection we found that significant progress had been made; comprehensive arrangements had been put into place to address the concerns. This included ensuring that temperatures were recorded each day and putting protocols in place for staff to follow if the temperatures were outside the expected ranges.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 16 November 2017

At our previous inspection on 24 August 2017, we rated the practice as requires improvement for providing safe services as the arrangements for storing vaccines were not satisfactory.

Since the previous inspection comprehensive arrangements had been put into place to address the concerns. We looked at the records maintained since the last inspection and saw that temperatures had been recorded each day the practice was open. On a small number of occasions the temperatures had been slightly above the recommended levels but the data loggers showed that this was for a very short period of time when vaccines were being put into the refrigerators.

Effective

Good

Updated 16 November 2017

Caring

Good

Updated 16 November 2017

Responsive

Good

Updated 16 November 2017

Well-led

Good

Updated 16 November 2017

Checks on specific services

People with long term conditions

Good

Updated 25 February 2016

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

Longer appointments and home visits were available when needed. The practice’s electronic system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. For those people with the most complex needs, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.

The practice held a weekly diabetic clinic which was attended by a dietician. Lead GPs had been identified for the most common long term conditions.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved good outcomes in relation to some of the conditions commonly associated with this population group. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with cancer, atrial fibrillation, depression, epilepsy and osteoporosis. However, performance in relation to other conditions was below average. For example, the practice had only obtained 83.7% of the points available to them for diabetes compared to 92.9% locally and 89.2% nationally.

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.

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for all routine vaccinations offered to children up to the age of five were above CCG averages.

At 82% the practice’s uptake for the cervical screening programme was the same as the clinical commissioning group (CCG) average.

Baby and immunisation clinics were held on a Wednesday morning. One of the GPs carried out six to eight week postnatal checks at the same time. This meant that any baby identified as needing to see a GP during the baby clinic or their immunisation appointment was able to see a GP immediately.

Requests for urgent appointments for children aged under one were facilitated the same day.

Older people

Good

Updated 25 February 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 99.9% and the England average of 97.9%.

The practice offered proactive, personalised care to meet the needs of the older people in its population. For example, all patients over the age of 75 had a named GP and patients at high risk of hospital admission and those in vulnerable circumstances had comprehensive care plans.

One of the GPs had been identified as the lead for elderly care. Patients recently discharged from hospital were contacted to ensure that their condition was stable and reduce the risk of readmission.

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 met. The practice was open from 8.20am to 6.30pm on a Monday to Friday (with appointments running from 8.30am to 6.15pm) and on a Saturday morning from 9am to 12 midday. As a result of patient feedback the Saturday morning surgery was staffed by either a GP or a nurse on an alternative week basis.

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group. The practice also offered a travel vaccination service.

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).

At 87% the percentage of patients diagnosed with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented was comparable with the national average of 88%. The percentage of patients with dementia whose care had been reviewed in a face to face meeting in the preceding 12 months was 74% (national average 84%).

Staff had received training on the Mental Capacity Act and Deprivation of Liberty Standards and the practice had achieved the Dementia Friends accreditation.

The practice hosted three trainee counsellors from the local Talking Therapies service. Patients with mental health issues who would benefit from counselling were offered appointments with the trainee counsellors in the first instance to reduce the waiting time to see a fully qualified counsellor.

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. Patients with learning disabilities were invited to attend the practice for annual health checks and were routinely offered a longer appointment.

The practice had effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.