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Archived: Allington Clinic Good Also known as CMG Healthcare

Inspection Summary


Overall summary & rating

Good

Updated 18 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Allington Clinic on 2 February 2016. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles.

  • All risks to patients were consistently assessed and well managed.

  • Patients’ records that contained confidential information were held in a secure way so that only authorised staff could access them.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to them. Feedback from patients about their care was consistently and strongly positive as well as significantly better than local and national feedback averages.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to help ensure that they met people’s needs. For example, in their professional interactions with a local nursing home, parents of and children on the ‘at risk’ register and those in vulnerable circumstances. There were regular six to eight weekly multidisciplinary meetings, as well as ‘as required’ meetings that were held if issues arose before the next scheduled meeting.

  • Urgent appointments were available the same day and pre bookable appointments were available up to four weeks in advance.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group (PPG). Patients who had had cause to complain were invited to join the PPG, in order to encourage them to be involved in the way the practice is operated.

  • 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.

  • There was a business plan that was monitored, regularly reviewed and discussed with all staff. High standards were promoted and owned by all practice staff with evidence of team working across all roles.

  • There was a clear leadership structure and staff felt supported by management.

  • Governance and performance management arrangements were under constant review. The practice actively sought out and used data from wide range of sources.

We saw areas of outstanding practice including:

  • The lead GP for safeguaring children knew the school nurse for each child and was aware of the issues at each school that the child attended, in order to help ensure they were aware of any mitigating factors which could have an impact on the child’s health.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 April 2016

The practice is rated as good for providing safe services.

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

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

  • When there were unintended or unexpected 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 to keep patients safe and safeguarded from abuse.

  • Risks to patients were assessed and well managed.

Effective

Good

Updated 18 April 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality. However, in some areas they scored below the average. For example, 76.4% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the CCG average of 85.5% and the national average of 83.9%. The practice had carried out an audit to determine why there was a shortfall in their results.

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

  • 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. For example, there were regular six to eight weekly multidisciplinary meetings, as well as ‘as required’ meetings that were held if issues arose before the next scheduled meeting. Care plans were routinely reviewed and updated during these meetings.

Caring

Good

Updated 18 April 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice in line with others for almost all aspects of care. For example, 87% of respondents said that the last GP they saw or spoke to was good at treating them with care and concern compared with a CCG average of 88% and national average of 85%.

  • Feedback from patients about their care and treatment was consistently and strongly positive. Patients’ views gathered at inspection demonstrated they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment. Patients told us verbally and in comment cards, that staff were exceptionally caring, went the extra mile and ensured that any follow up treatment required, was sensitively and compassionately explained to them.

  • We observed a strong patient-centred culture. Receptionists knew the patients well. Patients told us they received a very individualised and tailored service, which met their needs in relation to both their mental and physical well-being.

Responsive

Good

Updated 18 April 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to help ensure that they meet patients’ needs.
  • There were innovative approaches to providing integrated person-centred care. For example, in their professional interactions with a local nursing home, parents of and children on the ‘at risk’ register and those in vulnerable circumstances.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group. For example, patients who had had cause to complain were invited to join the patient participation group (PPG), in order to encourage them to be involved in the way the practice was operated.
  • Patients said they found it easy to make an appointment and there was continuity of care, with urgent appointments available the same day.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 18 April 2016

The practice is rated good for being well-led.

  • The practice had a clear vision and strategy.

  • Governance arrangements were underpinned by a clear leadership structure and staff felt supported by management.

  • Staff were aware of and understood the practices policies and procedures which governed activity.

  • There were systems to monitor and improve quality and identify risk.

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

  • 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 for knowing about notifiable safety incidents.

  • Staff had received induction, regular performance reviews and attended staff meetings and events.

  • High standards were promoted and owned by all practice staff. There was a very low staff turnover with a well-established team where staff worked across all roles.

  • The practice was aware of future challenges and had conveyed these to their PPG, in order to help ensure they were involved in future decision making. 
Checks on specific services

People with long term conditions

Good

Updated 18 April 2016

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

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

  • 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 people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

  • Longer appointments and home visits were available when needed.

Families, children and young people

Good

Updated 18 April 2016

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

  • There were systems to identify and follow up children living in disadvantaged circumstances and who were at risk. For example, children and young people who were on the ‘at risk register’. The practice ensured there was good coordination of care with other providers, such as the health visitor, midwife and health and social care coordinators.

  • The practice ensured there was good coordination with school nurse. The lead GP for safeguarding children knew the school nurse for each child and was aware of the issues at each school that the child attended, in order to help ensure they were aware of any mitigating factors which could have an impact on the child’s health.

  • Immunisation rates were relatively high for all standard childhood immunisations. Where families missed an appointment for a vaccination the practice followed this up by telephone.

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

  • The practice had bettered the national and local results for the cervical cancer screening programme. They had conducted an audit in order to evidence where cervical screening may be an issue for some female patients. The audit showed that a number of patients declined due to their nationality. As a result, the practice produced leaflets written in different languages regarding the benefits of cervical screening and had liaised with local community leaders to raise awareness amongst patients in this population group.

Older people

Good

Updated 18 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 patient population included a high number of patients who were aged 75 years and over. This included patients who were in a nursing home, where the practice provides long term and end of life care. There were regular six to eight weekly multidisciplinary meetings, as well as ‘as required’ meetings that were held if issues arose before the next scheduled meeting. As well as, integrated care meetings involving health and social care services which supported information sharing about vulnerable, elderly or housebound patients. GPs gave their personal contact telephone numbers to patients and their families/carers who were receiving palliative care at home and were contactable in the event of a crisis.

  • Repeat prescriptions were available over the telephone for older or housebound patients, who did not have, or who were not confident in using, the on-line repeat prescription service.

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

  • The practice provided un-funded care cover for 40 high dependency / end of life beds at a local nursing home. This included weekly ward rounds and daily visits when required.

Working age people (including those recently retired and students)

Good

Updated 18 April 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 patient population, those recently retired and students had been identified and the practice had adjusted the services it offered to help 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 April 2016

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

  • Quality and Outcomes Framework system results show that 76.4% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months, which was lower than the CCG average of 85.5% and the national average of 83.9%. The practice had carried out an audit to determine why there was a shortfall in their results.
  • 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 about how to access various support groups and voluntary organisations.

  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

People whose circumstances may make them vulnerable

Good

Updated 18 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 such as those who were elderly and lived alone or those with a learning disability.

  • The practice had carried out annual health checks for all patients with a learning disability. They offered longer appointments for patients with complex needs that related to their circumstances as well as their health concerns. The practice identified that there were a number of Nepalese and Eastern European patients registered with them and had translation services available if needed.

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