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Thatcham Health Centre Good Also known as Thatcham Medical Practice

Inspection Summary


Overall summary & rating

Good

Updated 21 December 2016

Letter from the Chief Inspector of General Practice

We carried out a desktop inspection of Thatcham Health Centre on 10 October 2016. We requested information from the practice to be sent to us so we could undertake a review of evidence offsite. This was following an announced comprehensive inspection in February 2016 in which the practice was rated as good for providing safe, effective, caring and well-led services and requires improvement for providing responsive services. This is because we identified concerns with the continuity of care as well as telephone accessibility for patients. We issued a requirement notice and rated the practice as requires improvement in the responsive domain. The practice sent us an action plan stating what they were going to do to make improvements. At this inspection we found:

  • Patient access had improved through the introduction of a new telephone system.
  • A new appointment system was introduced to help improve continuity of care.

During the previous inspection, we also reported on areas where improvements should be considered. At this inspection we found that the practice had also acted on these findings.

The practice had updated their carers identification protocal. This laid out what information was available within the practice to encourage carers to register and also what steps practice staff could take in order to refer them onto the carers register.

The areas where the provider should make improvement are:

  • Ensuring all patients who are carers are encouraged to register as such. Thus enabling the practice to offer the additional support available for this group of patients.
  • Continue to make improvements to telephone access to patients who need to book appointments.
  • Continue to review appointment systems to respond to patient concerns about continuity of care.

This report only covers our findings in relation to these requirements. You can read the report from out last comprehensive inspection by selecting the ‘all reports’ link for Thatcham Health Centre on our website www.cqc.org.uk 

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 15 April 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events

  • Lessons were shared to make sure action was taken to improve safety in the practice.

  • When there were safety incidents, patients received reasonable support, truthful information, a verbal and written apology. They were told about any actions to improve processes to prevent the same thing happening again.

  • 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 had joined the Sign up to Safety campaign aimed at reducing avoidable incidents of harm over the next three years.

Effective

Good

Updated 15 April 2016

The practice is rated as good for providing effective services.

  • The practice demonstrated improved monitoring of the care of patients diagnosed with diabetes and asthma. There had been a focus on care for these groups in 2015.

  • The practice had completed health checks for 41 out of 47 patients with a learning disability.

  • Data from the Quality and Outcomes Framework showed 14 out of 19 patient outcomes were at 100% achievementwhich was or equal or above average for the locality and compared to the national average.

  • Staff assessed needs and delivered care in line with current evidence based guidance and this was verified at the all clinicians meetings held on a monthly basis.

  • 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.

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

Caring

Good

Updated 21 December 2016

This practice is rated as good for providing caring services.

In February 2016 it was identified that the practice should ensure all patients who are carers were encouraged to register as such. At the time of the previous inspection the practice had identified 109 carers on their patient list which was 0.6% of the patient listing.

In October 2016 we received evidence that the number of patients registered as carers had increased to 177 which was 0.9% of the patient listing. 

Responsive

Good

Updated 21 December 2016

This practice is rated as good for providing responsive services.

In February 2016 feedback from patients who took part in the national patient survey reported that access to a named GP and continuity of care was not always available. Feedback also indicated that patients did not always find it easy to get through to the practice by phone.

In October 2016 we received evidence that practice had improved patient access to a named GP and continuity of care by revising their appointment system. They also had also introduced a new telephone system and had given telephone training to additional staff to help with demand during peak times.

Well-led

Good

Updated 15 April 2016

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

  • The practice had a vision and longer term 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.  Areas for improvement in responding to patient feedback on access had been identified and planned. However, it was too early to tell whether these would have a positive impact on responsive delivery of services.

  • 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 and ensured this information was shared with staff to ensure appropriate action was taken

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

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

Checks on specific services

People with long term conditions

Good

Updated 15 April 2016

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

  • Performance for diabetes related indicators was 80% which was below the CCG average of 86% and national average of 89%.

  • Performance for Asthma indicators was 93% which was below the CCG average of 95% and the national average of 97%.

  • The practice had excepted 13% of patients with long term conditions from monitoring compared to a national average of 9%.

There were, however, examples of good practice.

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. The practice had identified over 2% of patients at risk of hospital admission and care plans were in place for this group

  • Longer appointments and home visits were available when needed.

  • All these patients had a named GP and were offered 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.

Families, children and young people

Good

Updated 15 April 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 patients who had a high number of A&E attendances. Immunisation rates were relatively 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, and we saw evidence to confirm this.

  • The practice’s uptake for the cervical screening programme was 92%, which was above the CCG average of 77%% and the national average of 82%.

  • 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 and health visitors.

Older people

Good

Updated 15 April 2016

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 patients in its population.

  • The practice 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 better than the CCG and national averages.

  • Longer appointments and home visits were available for older people when needed.

  • There were over 200 patients registered with the practice who were living in care homes. GPs visited the larger care homes once each week and worked closely with community specialists in care of the elderly.

Working age people (including those recently retired and students)

Good

Updated 15 April 2016

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

  • Patient feedback showed that telephone access to the practice for booking appointments was proving difficult. Patients told us that having to call at 8am for appointments, and being kept waiting for the call to be answered, was awkward when preparing to go to work.

  • Patient feedback in the national survey showed the practice below average for patients being able to access their GP of choice. The practice result was 49% compared to the CCG average of 69% and national average of 59%.

There were, however, examples of good practice.

  • The practice offered evening appointments on four days a week and Saturday extended hours clinics were held on 23 occasions each year.

  • The practice was proactive in offering online services.

People experiencing poor mental health (including people with dementia)

Good

Updated 15 April 2016

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

  • The practice had identified 1.5% of their registered patients as living with dementia. Of these patients 85% had received a face to face review of their care.

  • Practice nurses visited patients living with dementia in their own homes to undertake their care reviews and if they needed any additional care and support.

  • The practice had achieved 100% of the national indicators for care of patients experiencing poor mental health and for those diagnosed with depression.

  • The GPs provided medical support for two care homes for older patients with mental health problems. There was regular liaison with the community outreach dementia nurse and the old age community mental health team to coordinate the care for these patients.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • The practice carried out advance care planning for patients living with dementia.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 15 April 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. Data showed 41 out of 47 of these patients had received an annual health check.

However,

  • The practice offered longer appointments for patients with a learning disability.

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

  • 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. 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 had formally identified 0.8% of patients as having caring responsibilities.