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Inspection Summary


Overall summary & rating

Good

Updated 19 July 2017

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Mill Bank Surgery on 17 May 2016. The overall rating for the practice was as ‘Good’ with requires improvement in providing a well led service. The full comprehensive report on the 17 May 2016 inspection can be found by selecting the ‘all reports’ link for Mill Bank Surgery on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 27 June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation identified in our previous inspection on 17 May 2016. This report covers our findings in relation to those requirements.

Overall the practice is rated as Good.

Our key findings were as follows:

  • The provider demonstrated that they shared information about serious incidents, with other relevant individuals or bodies without delay.

  • The practice had developed their significant event reporting process and ensured all incidents were recorded, reported and audited to maximise learning.

  • Nurse appraisals were carried out by GPs.

  • Patient paper record storage had been risk assessed and a locked area within the building was in the process of being developed.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 July 2017

Effective

Good

Updated 19 July 2017

Caring

Good

Updated 19 July 2017

Responsive

Good

Updated 19 July 2017

Well-led

Good

Updated 19 July 2017

The practice is rated as good for providing well led services.

  • The provider demonstrated that they shared information about serious incidents, with other relevant individuals or bodies without delay.

  • The practice had developed their significant event reporting process and ensured all incidents were recorded, reported and audited to maximise learning.

  • Nurse appraisals were carried out by GPs.

  • Patient paper record storage had been risk assessed and a locked area within the building was in the process of being developed.

  • The practice had 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 it.

  • There was a clear leadership structure and staff felt supported by the management team. The practice had policies and procedures to govern activity and held regular governance meetings.

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

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour.

  • The partners encouraged a culture of openness and honesty. The practice had systems for being aware of notifiable safety incidents and sharing the information with staff and ensuring appropriate action was taken.

  • The practice proactively sought feedback from staff and patients and we saw examples where feedback had been acted on. The practice engaged with the patient participation group.

  • There was a focus on continuous learning and improvement at all levels. Staff training was a priority and was built into staff rotas.

Checks on specific services

People with long term conditions

Good

Updated 5 July 2016

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

  • Patients at risk of hospital admission were identified as a priority.
  • One GP was identified as the lead for chronic illness and the nursing staff had lead roles in chronic disease management including asthma, coronary heart disease and chronic obstructive pulmonary disease (COPD).
  • Performance for the five diabetes related indicators were comparable or better than the local and national averages. For example, the percentage of patients with diabetes, on the register, in whom a blood pressure reading was recorded was 92% compared with the local average of 73% and national average of 78%.
  • Longer appointments and home visits were available when needed.
  • Patients had a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • Patients were able to enrol onto a system that enabled them to monitor their own blood pressure readings within their own environment after presenting to the GP with a high reading.
  • The practice held registers of people with long-term conditions.
  • The practice worked closely with Macmillan nurses, district nurses and the local hospice.

Families, children and young people

Good

Updated 5 July 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 on child protection plans.
  • Childhood immunisation rates were comparable to local averages for all standard childhood immunisations.
  • Patients had access to a Community Paediatric Nurse in addition to a midwife who held anti-natal clinics at the practice. Patients were provided with a maternity pack developed within the practice containing a range of information. New parents had access to newborn baby checks.
  • Same day urgent appointments were available for children.
  • Routine appointments were available outside of school hours and the premises were suitable for children and babies.
  • Flu clinics were held during half-term holidays at a time to suit parents and children.
  • The practice offered family planning and contraceptive services including implant fitting and coil insertion with a lead GP.
  • The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG average of 80% and the national average of 82%.

Older people

Good

Updated 5 July 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 people in its population.
  • Older people who were at risk of hospital admission or re-admission had a care plan in place and their care was reviewed with them on discharge and information shared during fortnightly practice meetings.
  • The practice was responsive to the needs of older people, and offered home visits, telephone appointments and urgent appointments for those with enhanced needs. The practice was also supported by the Acute Visiting Service (AVS). This service assisted the practice with meeting the needs of patients requiring urgent medical service at their home including care homes. The practice provided medical support to patients in 12 local care homes.
  • The practice was responsive to the needs of older people, and offered home visits, rapid access and telephone appointments for those with enhanced needs who were unable to attend the practice. This included patients in local care homes.
  • Older people had a named GP to help with their continuity of care.
  • A phlebotomy service was provided by the surgery, which enabled easier access for older people requiring a blood test. 

Working age people (including those recently retired and students)

Good

Updated 5 July 2016

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

  • The practice offered extended hours with GPs to help ease accessibility for patients.
  • 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 reflected the needs for this age group.
  • An electronic prescription service was available allowing late access to chemists for working people and students.
  • A chlamydia testing service was available to young people up to the age of 25.
  • The practice provided free NHS health checks for patients aged 40-74.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 July 2016

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

  • Patients with severe poor mental health were invited for an annual review of their health including a full physical and mental assessment with the practice nurse and Community Mental Health Nurse who attended the practice fortnightly. 89% of these patients had a comprehensive, agreed care plan in place compared with the CCG average of 90% and national average of 88%.
  • Patients with poor mental health were offered regular appointments and advised of the risks and benefits of their prescribed medicines such as controlled drugs. GPs were working with a small selection of patients to reduce their prescribed medicines.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, drug, and alcohol dependence and for those with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.
  • Patients diagnosed with dementia had annual reviews with the GP and were offered home visits when necessary. 76% of these patients had their care reviewed in a face-to-face meeting in the last 12 months. This was below the national average of 83% and CCG average of 84%. We saw information was displayed in the waiting area about dementia awareness week.

People whose circumstances may make them vulnerable

Good

Updated 5 July 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. The learning disability facilitator regularly updated the register.
  • The practice offered longer appointments for patients with a learning disability and offered annual health reviews.
  • 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.
  • A child protection register was maintained and updated and staff were made aware of those on the register.