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Clement Road Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 22 May 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection visit of Clement Road Medical Practice in August 2016. As a result of our comprehensive inspection the practice was rated as requires improvements for providing safe services. This was because we identified areas where the provider must make improvement and also some areas where the provider should improve.

We undertook a focused inspection on 12 April 2017 to check that the provider had made improvements in line with providing safe services. This report only covers our findings in relation to those requirements. You can read the report from our previous inspections by selecting the 'all reports' link for Clement Road Medical Practice on our website at www.cqc.org.uk.

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

  • During our comprehensive inspection on 25 August 2016 we found that the practice could not demonstrate that the nurses also received safety alerts. When observing the alerts process during our follow up inspection we saw that alerts were disseminated across the whole practice team and acted on where required.

  • When we inspected the practice in 2016 we found that systems were not effective across all areas such as following up on child missed appointments at hospital. As part of our most recent inspection, we noted that there was a process for monitoring and following up on missed hospital appointments, for adult and child patients. However, we found that the GPs did not always keep a record to evidence when they had reviewed the missed hospital appointments.

  • Previously we found that risk had not been assessed in the absence of emergency medicine associated with minor surgery and fitting specific contraceptive devices. We also found that regular fire alarm tests and fire drills had not taken place in the practice. During our follow up inspection we observed adequate stock of emergency medicine suitable for the practice and the services provided. Records were kept to demonstrate that the fire alarm was frequently tested and we saw that a fire drill had recently taken place.

  • When we inspected the practice in August 2016, we identified an area where the practice should improve with regards to supporting carers. During our follow up inspection we noted significant improvement and due to staff taking an active approach in identifying carers, we found that the carers register had increased from 3% to 4% between August 2016 and April 2017. These carers were offered support, flexible appointments and flu vaccinations.

  • For instance, due to staff taking an active approach to identifying carers we found that the carers register had increased from 3% to 4% between August 2016 and April 2017. Flu vaccinations were offered to carers and carers were included in the programme for flu vaccinations to ensure that they were contacted and offered a flu vaccine.

  • Since our previous inspection, comprehensive carer packs had been developed by the practice; these packs were handed out to all carers. The packs contained a wide range of information including signpost information to various carer support groups, this included support for young carers; to help the young carers identified on the practices register.

We identified one area of practice where the provider should make improvements:

  • Improve record keeping specifically when reviewing missed hospital appointments, to reflect the system used in practice when reviewing and following up on missed hospital appointments.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 May 2017

The practice is rated as good for providing safe services.

  • During our comprehensive inspection on 25 August 2016 we found that the practice could not demonstrate that the nurses received safety alerts. When observing the alerts process during our follow up inspection we saw that alerts were disseminated appropriately and we saw various examples of alerts shared with members of the nursing team, GPs and non-clinical staff for information purposes.

  • Previously, we found that systems were not effective across all areas such as following up on child missed appointments at hospital. As part of our most recent inspection, we found that the practice operated a more effective process for monitoring and following up on missed hospital appointments, for both adult and child patients. However, we found that the GPs did not always keep a record to evidence when they had reviewed missed hospital appointments.

  • When we looked at the practices emergency medicines during our previous inspection we found that risk had not been assessed in the absence of emergency medicine associated with minor surgery and fitting specific contraceptive devices. We also found that regular fire alarm tests and fire drills had not taken place in the practice.
  • During our follow up inspection saw that the emergency equipment and emergency medicines were regularly checked to ensure they were in date and fit for use and there was adequate stock of emergency medicine suitable for the practice and the services provided. We saw that the fire alarm was frequently tested and we saw that a fire drill had recently taken place.

Effective

Good

Updated 22 May 2017

Caring

Good

Updated 22 May 2017

Responsive

Good

Updated 22 May 2017

Well-led

Good

Updated 22 May 2017

Checks on specific services

People with long term conditions

Good

Updated 12 October 2016

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

  • The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

  • The practice offered a range of clinical services which included care for long term conditions.

  • QOF performance for 2014/15 for diabetes related indicators was 83%, compared to the CCG average of 89% and national average of 90%. More recent data provided by the practice highlighted that diabetes performance had improved and was at 100%.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • The percentage of patients with hypertension having regular blood pressure tests was 100%, with an exception rate of 8%.

Families, children and young people

Good

Updated 12 October 2016

The practice is rated as good for the care of families, children and young people.

  • The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

  • Practice data highlighted that during the last 12 months they had 21 missed hospital appointments for registered patients under the age of 16, however we found that the practice did not follow a system to actively review these instances and follow up where necessary.

  • Childhood immunisation rates for under two year olds for 2014/15 ranged from 79% to 97% compared to the CCG averages which ranged from 83% to 98%. More recent data provided by the practice highlighted that immunisation rates for under two year olds ranged from 85% and 94%. Immunisation rates for five year olds ranged from 95% to 100% compared to the CCG average of 93% to 98%.
  • Current data provided by the practice highlighted that cervical screening rates had improved since 2014/15 when the practice’s uptake for the cervical screening programme was 66%, compared to the CCG average of 73% and national average of 74%. Current results were in line with the local target of 80%.

Older people

Good

Updated 12 October 2016

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

  • The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

  • The practice offered personalised care to meet the needs of the older people in its population. It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

  • Immunisations such as flu vaccines were also offered to patients at home, who could not attend the surgery.
  • The practice worked with the local Dudley Council for Voluntary Service (CVS) team to help to provide social support to their patients who were living in vulnerable or isolated circumstances. This included members of the practices older population.

Working age people (including those recently retired and students)

Good

Updated 12 October 2016

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

  • The practice is rated as requires improvement for providing safe and well led services; this affects all six population groups.

  • The practice was proactive in offering a full range of health promotion and screening that reflects the needs for this age group. The practice offered a range of clinical services which included minor surgery, family planning, travel and well person clinics.

  • Practice data highlighted that 30% of their patients had been identified as needing smoking cessation advice and support and 6% had successfully stopped smoking.
  • Appointments could be booked over the telephone, face to face and online. The practice also offered telephone consultations with a GP at times to suit patients. The practice offered text messaging reminders for appointments to remind patients of their appointments in advance.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 October 2016

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

  • There were longer appointments available at flexible times for people experiencing poor mental health. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice also supported patients who were experiencing poor mental health by referring them to a gateway worker who provided counselling services on a weekly basis in the practice.

  • QOF performance for 2014/15 regarding mental health related indicators was 68%, compared to the CCG average of 93% and the national average of 92%. More recent data provided by the practice highlighted that performance for mental health related indicators had improved and was at 100%. However, practice data highlighted that only 63% of these patients had an agreed care plan in place.
  • Recent data provided by the practice indicated that appropriate diagnosis rates for patients identified with dementia were at 100%.

People whose circumstances may make them vulnerable

Good

Updated 12 October 2016

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

  • The practice offered longer appointments for patients with a learning disability.
  • There were 31 patients on the practices learning disability register, 68% of these patients had care plans in place and 55% of the eligible patients had received a medication review in a 12 month period.
  • Vulnerable patients were regularly reviewed and discussed as part of the multidisciplinary team meetings to support the needs of patients and their families.
  • Practice data highlighted that approximately 16% of the practices list were from different ethnic groups and some of these patients did not speak English as a first language. The practice developed an accessible information pack so that patients were able to make specific requests such as information in a particular format or specific support such as translation requirements.