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Steyning Medical Practice Good Also known as The Steyning Health Centre

Inspection Summary


Overall summary & rating

Good

Updated 25 August 2017

Letter from the Chief Inspector of General Practice

When we visited Dr Noren & Partners at

Steyning Health Centre on 10 January 2017 to carry out a comprehensive inspection,

we rated them as good overall. However, we found the practice required

improvement for the provision of effective services and we told them that they

must:

  • Assess, monitor and mitigate risks relating

    to the health, safety and welfare of patients related to repeat medicine

    reviews.

We also said they should:

  • Continue to work towards improving the

    recording of care outcomes for patients with chronic obstructive pulmonary

    disease.

Following our inspection, the practice sent

us an action plan setting out the action they would take to meet the legal

requirements in relation to the breaches in regulations that we had identified.

This inspection was an announced focused

inspection carried out on 21 July 2017 to confirm that the practice had carried

out their action plan and was now meeting the legal requirements. This report

should be read in conjunction with the full report of our inspection on 10

January 2017, which can be found on our website at

www.cqc.org.uk

.

We have amended the rating for this practice

to reflect these changes. The practice is now rated good for the provision of

effective services. Overall the practice remains rated as good.

 

On our inspection of 21

July 2017 we found the practice had made improvement and now met the legal

requirements in the areas they had previous breached. Specifically we found:

  • The practice had reviewed their process for ensuring patients on repeat

    medicines had these medicines reviewed at appropriate intervals. They had taken

    action in a number of areas and we saw data that showed significant

    improvement. For example, in the 12 months  up to 21 July 2017, 80% of patients on four or

    more medicines had a medicine review recorded in their notes compared to the

    51% we found at our previous inspection.

  • The practice had continued to improve their reviewing

    and recording of care outcomes for patients with chronic obstructive pulmonary

    disease (a chronic lung disease). We saw data which showed that for the year

    April 2016 to March 2017 the practice had achieved 33 of the 35 quality

    framework points available to them.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 February 2017

The practice is rated as good for providing safe services.

  • Risks to patients assessed and well managed. Medicines were managed in line with national guidance.
  • Lessons were shared to make sure action was taken to improve safety in the practice as a result of significant events.
  • When things went wrong patients received reasonable support, truthful information and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • Arrangements were in place to safeguard children and vulnerable adults from abuse.
  • Equipment was checked and calibrated.
  • There were health and safety policies in place.

Effective

Good

Updated 25 August 2017

When we visited Dr Noren & Partners at

Steyning Health Centre on 10 January 2017 to carry out a comprehensive

inspection, we rated them as required improvement for the provision of effective

services. We found breaches in the regulation relating to safe care and

treatment.

We undertook this focused follow up

inspection of the practice on the 21 July 2017  to review the actions they had taken to

improve the quality of care and to confirm that the practice was now meeting

legal requirements.

We found the practice had made improvements

and was now meeting the legal requirements in the areas they had previous

breached. Specifically we found:

  • The practice had reviewed their process for ensuring patients on repeat

    medicines had these medicines reviewed at appropriate intervals. They had taken

    action in a number of areas and we saw data that showed significant

    improvement. For example, in the 12 months  up to 21 July 2017 80% of patients on four or

    more medicines had a medicine review recorded in their notes compared to the

    51% we found at our previous inspection.

  • The practice had continued to improve their

    reviewing and recording of care outcomes for patients with chronic obstructive

    pulmonary disease.

    We saw data which showed that for the year

    April 2016 to March 2017 the practice had achieved 33 of the 35 quality

    framework points available to them.

The practice is now rated as good for the provision of

effective services.

Caring

Good

Updated 22 February 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for most aspects of care.
  • Patient feedback from comment cards stated 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 saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 22 February 2017

The practice is rated as good for providing responsive services.

  • The practice improved services continuously even where patient feedback was overall highly positive.
  • Specifically, the management team and partners noticed that there was some negative feedback on the national GP survey regarding waiting times and seeing a preferred GP in summer 2016. To improve this, the practice introduced timings for patients who attended a walk-in service so they would know how long they would need to wait. They also identified means of improving pre-bookable appointment availability with GPs.
  • The practice implemented ‘patient care advisers’ to support any patients who were unable to get an appointment in advance or other requests which could not be fulfilled by reception. In these cases receptionists could refer a patient’s request to one of three care advisers who would contact the patient and offer an alternative that best met the patient’s needs.
  • Where the practice identified vulnerable patients, bespoke action was taken to meet the needs of these patients. For example, the GPs working in the locality identified that the number of falls among frail and elderly patients was higher than other areas. The practice led on a local project to educate those at risk of falls to reduce these risk factors.
  • A charity for patients who experience deafness and another who support blind people were asked to come and provide training to all the practice staff to help improve their ability to support patients with hearing difficulties and those with limited or no sight.
  • Fifteen minute appointments were provided to patients where they were identified as having enhanced needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Complaints were formally reviewed to identify trends and ensure changes to practice had become embedded.
  • Verbal and written feedback was considered by the practice and if negative accepted as a complaint and investigated.

Well-led

Good

Updated 22 February 2017

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

  • The practice had a clear vision and staff were clear about the vision and their responsibilities in relation to it.
  • Risks were assessed and well managed.
  • However, medicine reviews were not always monitored appropriately.
  • 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.
  • The practice had systems in place for notifiable safety incidents and ensured this information was shared with staff so that appropriate action was taken.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active and the partners and practice manager were involved in it.
  • There was a strong ethos of continuous improvement and learning. Staff were encouraged to undertake training and new roles where they wished to.
Checks on specific services

People with long term conditions

Good

Updated 22 February 2017

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 had appropriate training.
  • Patients at risk of hospital admission were identified as a priority.
  • Nurses were supported by lead GPs in each clinical area and met regularly to discuss care and treatment processes and individual patients.
  • The most recent published results showed the practice was performing well compared to national averages and local averages.
  • Medicine reviews were not always recorded properly on the record system and therefore not necessarily always monitored effectively
  • All these patients were offered structured annual review to check their health 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.
  • National data regarding Chronic obstructive pulmonary disease performance showed improvements were required. The practice had made plans to improve this performance.
  • Diabetes care was highly personalised and there was work to identify patients at risk of diabetes and manage the risk to their health.

Families, children and young people

Good

Updated 22 February 2017

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.
  • The practice’s uptake for the cervical screening programme was 82%, which was similar to the national average of 82%.
  • Immunisation rates were similar to average for most standard childhood immunisations, but lower for one area.
  • Staff explained how they treated children and young people in an age-appropriate way including recognition of their rights to access treatment.
  • We saw positive examples of joint working with midwives and health visitors.
  • Joint working with external organisations took place in the management of children at risk of abuse.
  • The patient participation group provided talks for young people on their specific areas of health concerns, such as sexual health.

Older people

Good

Updated 22 February 2017

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

  • The practice offered proactive, personalised care to meet the needs of the high proportion of older people in its population.
  • GPs offered personalised care to patients in care and nursing homes.
  • The premises were accessible for patients with limited mobility.
  • Medicine reviews were not always recorded properly on the record system and therefore not necessarily always monitored effectively.
  • Patients over 75 had a named GP to maintain continuity of care.
  • Care planning was provided for patients with dementia.
  • Patients at risk of admission to hospital were provided with care plans.
  • Early visiting home visits were provided where necessary and also a paramedic practitioner was employed to undertake home visits.

Working age people (including those recently retired and students)

Good

Updated 22 February 2017

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 considered and the practice had adjusted the services it offered enable continuity of care.
  • Patients’ feedback on the appointment was higher than the national and local GP survey averages.
  • The practice responded to any areas where the appointment system could be improved by implementing minor illness nurses and additional support systems to help patients’ book appointments.
  • Extended hours appointments were available three days a week.
  • The practice was proactive in offering online services
  • A full range of health promotion and screening was available that reflects the needs for this age group.
  • Travel vaccinations were available both privately and on the NHS.

People experiencing poor mental health (including people with dementia)

Good

Updated 22 February 2017

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

  • Performance for mental health related indicators in 2016 was 100% compared to the national average of 93% and regional average of 91%.
  • The proportion of patients on mental health register with an up to date care plan and an up to date physical assessment was 63%. 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 advanced care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 22 February 2017

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

  • Patients with learning disabilities were offered annual health checks.
  • The practice held a register of patients living in vulnerable circumstances including patients with dementia and learning disabilities.
  • The practice offered longer appointments for vulnerable patients.
  • A list of 470 patients deemed as requiring priority appointments were listed as gold patients. This enabled priority to be provided for appointments or call back by receptionists. Patients on the palliative care register, cancer register, some patients with multiple morbidities, those with dementia and carers could become gold patients.
  • Patients with no fixed address could register at the practice if needed and homeless patients could be referred to a local specialist GP service.
  • The practice regularly worked with other health care professionals 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.
  • Joint working with external organisations took place in the management of patients at risk of abuse or harm.