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Manor Park Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 7 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Manor Park Medical Centre, 2 Lerwick Drive, Slough, SL1 3XU on 21 October 2015. Overall the practice is rated as good.

Specifically, we found the practice was good for providing safe, effective, responsive, caring and well led services.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. The majority of information about safety was recorded. However, reviews and follow ups of significant events and incidents were not thorough enough and lessons learned were not always communicated widely enough to support improvement.

  • Risks to patients were assessed and well managed.

  • We found that completed clinical audits cycles were driving positive outcomes for patients. However, the practice did not have a planned programme of future audits to ensure continuous monitoring and improvement.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain were available and easy to understand.

  • Patients said they found it easy to make an appointment with a named GP, with urgent appointments available the same day.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw two areas of outstanding practice:

  • The practice had responded to the needs of ethnic minority patients with long term conditions by developing a voluntary self-funded ‘meri-sehat’ (my-health) project that recognised the needs of patients who were feeling depressed and socially isolated due to cultural difference and language barrier. The project was aimed at and data showed that outcomes for vulnerable patients with long term conditions had improved. For example, the practice had carried out a satisfaction survey. This demonstrated that patient outcomes were extremely positive and patients were feeling more motivated, alert, happy and included in society. We also noted the positive impact on prescribing rates because patients were self managing their long term conditions better due to improved lifestyles. For example, the practice had lowest prescribing and emergency admission rates compared to other practices in the local clinical commissioning group (CCG).

  • One of the GPs had carried out an extensive research project on diabetes for three years. The practice had 90% South Asian patient population with high prevalence rates of diabetes. The practice was providing in-house diabetic management services to 1076 diabetic patients (10.4% of the patient list size). The practice had carried out repeat audits as part of a research project on 290 patients with diabetes. These audits showed diabetic patient outcomes were above average, for example, substantial reductions of blood sugar levels with lifestyle changes controlled by diet, a significant reduction in cholesterol, weight loss and a reduction in medicines prescriptions used to manage diabetes. We saw the practice was delivering the most cost effective diabetic services compared to other practices in the CCG.

In addition the provider should:

  • Review the process for investigating and implementing change from incidents, significant events and complaints to ensure actions are completed. Improve the recording of discussions and actions during practice meetings.

  • Ensure all staff have completed role specific mandatory infection control training and the practice should review training guidance according to infection control assurance framework.

  • Ensure shared care plans for patients on the high risk of admission register are available to external organisations.

  • Ensure an induction pack is available for locum GPs.

  • Further review the waiting time it takes to get through to the surgery by phone.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 January 2016

The practice is rated as good for providing safe services.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. However, when there were unexpected significant events and safety incidents, the system for review and follow up was inconsistent. Lessons learnt were not always communicated widely enough to support improvement.

  • Risks to patients were assessed and well managed.

  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse.

  • There was an infection control protocol in place and infection control audits were undertaken regularly. We found the infection control lead and all GPs had not completed up to date infection control training.

Effective

Good

Updated 7 January 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.

  • Staff assessed need and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement. However, clinical audits were carried out on an ad-hoc basis and there was no planned programme of future audits.

  • 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.

  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patient’s needs.

  • The practice had created care plans of patients at high risk admissions register to reduce the risk of these patients needing admission to hospital. However, the practice was not sharing all relevant information with other services in a timely way, for example there was no evidence of shared care plans of patients on high risk admission register, which was putting patients at risk.

Caring

Good

Updated 7 January 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice at or above average than others in locality for several aspects of care.

  • 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.

  • We also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 7 January 2016

The practice is rated as good for providing responsive services.

  • It reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified. For example, the practice had secured funding for a building extension and was in discussion with other local surgeries for developing a community health hub for seven day extended care services.

  • The practice had responded to the needs of ethnic minority patients with long term conditions by developing a voluntary self-funded ‘meri-sehat’ (my-health) project that recognised the needs of patients who were feeling depressed and socially isolated due to cultural difference and language barrier.

  • Patients said they found it easy to make an appointment with a named GP, with urgent appointments available the same day. However, the practice recognised that they were required to monitor and improve the waiting time it takes to access the surgery by phone.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 7 January 2016

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

  • There was a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to this.

  • 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 an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • The provider was aware of and complied with the requirements of the Duty of Candour. The partners encouraged a culture of openness and honesty. The practice had systems in place for knowing about notifiable safety incidents.

  • The practice proactively sought feedback from staff and patients, which it acted on. There was an active patient participation group.

  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Outstanding

Updated 7 January 2016

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

  • There were clinical leads for chronic disease management and patients at risk of hospital admission were identified as a priority.

  • The practice had responded to the needs of ethnic minority patients with long term conditions by developing a voluntary self-funded ‘meri-sehat’ (my-health) project and data showed that outcomes for vulnerable patients with long term conditions had improved.

  • We also noted the positive impact on prescribing rates because patients were self managing their long term conditions better due to improved lifestyles.

  • The practice was providing in-house diabetic management programme including diabetic eye screening. We saw the practice was delivering the most cost effective diabetic services compared to other practices in the CCG.

  • Data showed patient outcomes were 63% to 96% on average for all long term condition medicine reviews.

  • Longer appointments and home visits were available when needed.

  • All patients with long term conditions had a named GP and a structured annual review to check that 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 7 January 2016

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

  • 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 patients who had a high number of A&E attendances.

  • Immunisation rates were high for all standard childhood immunisations.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals.

  • The practice’s uptake for the cervical screening programme was 78%, which was above to the CCG average of 72% and below to the national average of 80%.

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

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

Older people

Good

Updated 7 January 2016

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

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

  • The percentage of patients aged 65 or over who received a seasonal flu vaccination was higher than the national average.

  • The premises were accessible to those with limited mobility.

  • There was a register to manage end of life care and unplanned admissions.

  • There were good working relationships with external services such as district nurses.

Working age people (including those recently retired and students)

Good

Updated 7 January 2016

The practice is rated as good for the care of working-age patients (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.

  • Extended hours appointments were available three mornings from 7:30am to 8am and three evenings from 6:30pm to 7pm.

People experiencing poor mental health (including people with dementia)

Good

Updated 7 January 2016

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

  • 93% of patients experiencing poor mental health were involved in developing their care plan in last 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

  • The practice had told patients experiencing poor mental health how to access various support groups and voluntary organisations.

  • Systems were in place to follow up patients who had attended accident and emergency, when experiencing mental health difficulties.

  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 7 January 2016

The practice is rated as good for the care of patients 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 did not have any homeless patients or travellers.

  • It offered annual health checks for patients with learning disabilities. Health checks were completed for 32 patients out of 42 patients on the learning disability register.

  • Longer appointments were offered to patients with a learning disability.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients.

  • It had told 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.