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The Croft Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 3 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Croft Medical Centre on 13 October 2016. Overall the practice is rated as good.

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

  • There was an effective system in place for reporting and recording significant events and lessons were shared to make sure action was taken to improve safety in the practice.

  • There was a clear process to receive and review safety alerts

  • The practice had two safeguarding leads to ensure there was consistent cover in the event of an absence. Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • The practice used templates specific to the patient record system to ensure treatment and care was in line with best practice, for example diabetes.

  • The practice had a structured approach to clinical audits to demonstrate quality improvement.

  • The practice proactively reviewed patient care plans, including for those identified as high risk of admission to hospital. Any discharges from hospital were reviewed on a daily basis and care plans were amended as appropriate.

  • The practice identified patients who may be in need of extra support and signposted them to the relevant service.

  • Patients said they felt the practice offered an excellent service and felt welcomed by all staff. They also told us they felt listened to and supported by staff who also gave advice on how to self manage their conditions.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

  • The practice identified carers and provided appropriate support and guidance.

  • Data from the national GP patient survey showed patients rated the practice lower than others with regards to access to the practice. However, the practice had recognised this and took action to improve access.

  • Members of the patient participation group told us the practice had made changes to the appointment system to improve the access to the practice by telephone.

  • There were robust arrangements for identifying, recording and managing risks, issues and implementing mitigating actions.

  • The practice held various monthly meetings to ensure governance issues were discussed and actions were taken as necessary, for example discussion of significant events, complaints, audits and safety alerts.

  • There was a strong focus on continuous learning and improvement at all levels and the practice had been nominated in 2015 and 2016 for GP Awards.

The areas where the provider should make improvement are:

  • Continue to review patient satisfaction, specifically in relation to patient access.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 3 February 2017

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events and lessons were shared to make sure action was taken to improve safety in the practice.

  • There was a clear process to receive and review safety alerts

  • The practice had two safeguarding leads to ensure there was consistent cover in the event of an absence. Staff demonstrated they understood their responsibilities and all had received training on safeguarding children and vulnerable adults relevant to their role.

  • Arrangements were in place for planning and monitoring the number of staff and mix of staff needed to meet patients’ needs.

  • All staff received annual basic life support training and there was a business continuity plan in place in the event of a major disruption to the service.

Effective

Good

Updated 3 February 2017

The practice is rated as good for providing effective services.

  • Two GP partners were responsive for ensure all relevant NICE guidance was accessible on the practice intranet site and up to date. Guidance was reviewed and discussed as appropriate and changes were made to local protocols as appropriate.

  • The practice used templates specific to the patient record system to ensure treatment and care was in line with best practice, for example diabetes.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average.

  • The practice had higher exception reporting rates than the national average for some clinical indicators in 2014/15. The practice had completed a detailed analysis and comparison to the 2015/16 data. The practice clearly identified some discrepancies in the data, however where exception reporting was higher than the national average the practice had identified the reasons including incorrect coding and the actions they would take as a result.

  • The practice had a structured approach to clinical audits to demonstrate quality improvement.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment.

  • The practice proactively reviewed patient care plans, including for those identified as high risk of admission to hospital. Any discharges from hospital were reviewed on a daily basis and care plans were amended as appropriate.

  • The practice identified patients who may be in need of extra support and signposted them to the relevant service.

Caring

Good

Updated 3 February 2017

The practice is rated as good for providing caring services.

  • Patients said they felt the practice offered an excellent service and felt welcomed by all staff. They also told us they felt listened to and supported by staff who also gave advice on how to self manage their conditions.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.

  • 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.

  • The practice identified carers and provided appropriate support and guidance.

Responsive

Good

Updated 3 February 2017

The practice is rated as good for providing responsive services.

  • Practice staff 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.

  • Data from the national GP patient survey showed patients rated the practice lower than others with regards to access to the practice. However, the practice had recognised this and took action to improve access.

  • Members of the patient participation group told us the practice had made changes to the appointment system to improve the access to the practice by telephone.

  • 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 the practice responded quickly to issues raised.

Well-led

Good

Updated 3 February 2017

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

  • The practice had a clear strategy and objectives in place to ensure the practice vision was achieved.

  • There were robust arrangements for identifying, recording and managing risks, issues and implementing mitigating actions.

  • The practice held various monthly meetings to ensure governance issues were discussed and actions were taken as necessary, for example discussion of significant events, complaints, audits and safety alerts.

  • The practice proactively sought feedback from staff and patients, which it acted on. A staff steering group had also been introduced to increase communication between staff and the management and partner teams.

  • The patient participation group was active and felt supported by the practice.

  • There was a strong focus on continuous learning and improvement at all levels and the practice had been nominated in 2015 and 2016 for GP Awards.

Checks on specific services

People with long term conditions

Good

Updated 3 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 patients at risk of hospital admission were identified as a priority.

  • 80% of those diagnosed with diabetes had a blood test to assess diabetes control (looking at how blood sugar levels have been averaging over recent weeks) compared to the national average of 78%.

  • 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 and personalised care plans were implemented.

  • The practice was involved in a pilot to improve pain management for patients over 65 with long term conditions.

Families, children and young people

Good

Updated 3 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.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • The practice’s uptake for the cervical screening programme was 78%, which was comparable to the CCG average of 78% and the national average of 74%.

  • 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, health visitors and school nurses.

Older people

Good

Updated 3 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 older people in its population.

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

  • The practice were able to refer patients to an Integrated Care Facilitator employed by the local council to ensure support was provided holistically.

Working age people (including those recently retired and students)

Good

Updated 3 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 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, including bookin appointments and requesting repeat prescriptions.

  • A full range of health promotion and screening was offered that reflected the needs for this age group.

  • The practice hosted a physiotherapy service and ultrasound service which had shown a reduction in the number of referrals to secondary care.
  • A walk-in blood clinic was available on a daily basis between 8am and 9.45am. Patients were also able to book an appointment for a blood test.

People experiencing poor mental health (including people with dementia)

Good

Updated 3 February 2017

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

  • 97% of those with a diagnosis of schizophrenia, bipolar affective disorder or other had a comprehensive and agreed care plan in place, compared to the national average of 89%.

  • 85% of patients with a diagnosis of dementia had their care reviewed in a face-to-face review, compared to the national average of 84%.

  • 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 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 3 February 2017

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 travellers and those with a learning disability.

  • The practice offered longer appointments for patients with a learning disability and an annual health check.

  • 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.

  • The practice had two safeguarding leads and staff were knowledgeable about their roles and responsibilities if they had concerns about a patient.