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Kingsbridge Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 30 May 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Kingsbridge Medical Centre on 11 July 2016. The overall rating for the practice was good with requires improvement in providing safe services. The full comprehensive report on the 11 July 2016 inspection can be found by selecting the ‘all reports’ link for Kingsbridge Medical Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 10 May 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 11 July 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

  • Improvements had been made in the recruitment of locum GPs however several gaps remained. The practice took immediate action on the day of the inspection to mitigate the gaps and updated their policy for employing agency workers to ensure the safe recruitment of future locum GPs.

  • An appropriate emergency medicine was available at the practice to treat possible complications associated with the insertion of inter uterine coils.

  • A system had been implemented to monitor and follow up children who did not attend hospital appointments.

  • A system had been put in place to regularly monitor fridge temperatures to ensure vaccines were stored within the manufacture’s recommended temperature range.

  • A protocol for dealing with uncollected prescriptions had been developed and implemented.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Date all policies to ensure policies are reviewed and updated within an appropriate time frame.

  • Ensure the updated policy for the employment of agency workers is fully implemented.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 30 May 2017

  • Improvements had been made in the recruitment of locum GPs however several gaps remained. The practice took immediate action on the day of the inspection to mitigate the gaps and updated their policy for employing agency workers to ensure the safe recruitment of future locum GPs.

  • An appropriate emergency medicine was available at the practice to treat possible complications associated with the insertion of inter uterine coils.

  • There was a system in place to monitor and follow up children who did not attend hospital appointments.

  • A system was in place to regularly monitor fridge temperatures to ensure vaccines were stored within the manufacture’s recommended temperature range.

  • A protocol for dealing with uncollected prescriptions had been developed and implemented.

Effective

Good

Updated 30 May 2017

Caring

Good

Updated 30 May 2017

Responsive

Good

Updated 30 May 2017

Well-led

Good

Updated 30 May 2017

Checks on specific services

People with long term conditions

Good

Updated 20 September 2016

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

  • Performance was higher than the local and national average in all except one of the diabetes related indicators. For example,

    the percentage of patients with diabetes, on the register, who had influenza immunisation was 99%, this was higher than the CCG average and the national average of 94%. The percentage of patients on the diabetes register, with a record of a foot examination and risk classification was 85% compared to the CCG average of 84% and the national average of 88%.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.

  • Longer appointments and home visits were available when needed.

  • 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 had produced self-management plans for patients with diabetes, asthma and chronic obstructive pulmonary disease.

Families, children and young people

Good

Updated 20 September 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. However, there was not a robust system for following up or documenting outcomes for children who did not attend hospital appointments.

  • Immunisation rates were high for all standard childhood immunisations.

  • The practice’s uptake for the cervical screening programme was 82% which was the same as the CCG and the national average.

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

  • Same day emergency appointments were available for children.

  • We saw positive examples of joint working with midwives, health visitors and school nurses.

  • Weekly well baby clinics were held at the practice and baby checks were carried out in house.

  • The midwife held twice a week clinics at the practice.

  • The surgery offered contraception services including oral contraception, intrauterine devices and contraceptive implants.

Older people

Good

Updated 20 September 2016

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

  • The practice had a higher proportion of older patients when compared with local and national averages.

  • 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 all patients over 85. year and urgent appointments for those with enhanced needs. In 2015-2016, 307 visits were carried out. As a result of these visits, a total of 74 referrals had been made to services such as social services, memory clinic, falls clinic and physiotherapy. The practice had assisted 129 patients with making benefit claims and assisted 61 patients to apply for their blue badge.

  • All patients over the age of 75 years had a named GP.

Working age people (including those recently retired and students)

Good

Updated 20 September 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 reflected the needs for this age group.

  • Extended hours appointments were available each Saturday morning.

  • The practice had a web site allowing patients to order medication, make and cancel appointments and email the practice with questions.

  • A sphygmomanometer (instrument for measuring blood pressure) was available in the waiting room so patients could drop in for a blood pressure check without needing to make an appointment.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 September 2016

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

  • The percentage of patients diagnosed with dementia whose care had been reviewed in

    a face-to-face review in the last 12 months was 84%, which was the same as the CCG and the national average.

  • The percentage of patients with schizophrenia, bipolar affective disorder and other

    psychoses who had a comprehensive, agreed care plan documented in the record, in the last 12 months was 93% compared with the CCG average of 87% and the national average of 88%.

  • 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, patients with serious mental health problems, and patients with opioid addiction. This covered social aspects, physical and mental health.

  • 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 dementia.

  • The practice provided a shared care opioid maintenance programme for patients with opioid addiction.

  • Same day appointments are given to patients in crisis.

People whose circumstances may make them vulnerable

Good

Updated 20 September 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.

  • 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.

  • A review of admissions for the 2% most vulnerable patients registered with the practice was undertaken. Vulnerable patients who attended the A&E department or were admitted to hospital were reviewed weekly at practice meetings.

  • 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. Staffs 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 had identified 80 patients as carers (0.94% of the practice list). Written information was available to direct carers to the various avenues of support available to them. The practice had a named carers’ champion who acted as the point of contact for carers.