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Gravesend Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 29 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gravesend Medical Centre on 29 June 2016.  Overall the practice is rated as good.

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

  • There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events and learning from these was discussed and shared.

  • Risks to patients were assessed and well managed, including an infection control audit with identified actions, however some flooring in non-public areas of the practice required maintenance.

  •  Medicines were well-managed within the practice.

  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained and had received updates to training to provide them with the skills, knowledge and experience to deliver effective care and treatment.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns and the practice was open and transparent in responding to complaints and concerns.

  • Most patients we spoke with said they found it easy to make an appointment  and that there were urgent appointments available the same day, however, the response to the GP patient survey rated the practice lower than the CCG and national averages.

  • The practice worked closely with other organisations and the community to plan and implement services according to patient need.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • There was a clear leadership structure and staff felt supported by management. The practice proactively sought feedback from staff and patients, which it acted on.

  • The provider was aware of and complied with the requirements of the duty of candour.

  • The patient participation group was active at the practice and improvements were made as a result of their input, reflecting the patient voice.


We saw two area’s of outstanding practice:

The practice involved the patient participation group in the interview process for the recruitment of GP’s.

The practice had set up and established a community initiative called the Breath Easy Group which is a monthly meeting for local patients and carers with Chronic Obstructive Pulmonary Disease (COPD).

The areas where the provider should make improvements are:

  • Review the need for a hearing loop at the practice.

  • Undertake maintenance to areas of flooring in the staff kitchen and second floor accessible toilet.

  • Continue to address issues identified by the GP Patient Survey to improve patient satisfaction.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 29 September 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 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.
  • The practice had clearly defined and embedded systems, processes and practices in place to help keep patients safe and safeguarded from abuse.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 29 September 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were above average compared to the national average.
  • 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 other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 29 September 2016

The practice is rated as good for providing caring services.

  • Patients views gathered at inspection showed that they felt treated with dignity and respect and involved in decisions about their treatment and care, and we observed that staff treated patients with kindness and respect and maintained confidentiality. However, data from the national GP patient survey showed patients rated the practice lower than others for several aspects of care compared to local and national averages. The practice were aware of this and working with the patient participation group (PPG) to make changes according to the results of the patient survey.
  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 29 September 2016

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.
  • Feedback from patients regarding how easy it was to make an appointment at the practice was varied and the Patient Survey results were lower than local and national averages.
  • Urgent appointments were 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 evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 29 September 2016

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

  • 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 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 and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • 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 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 involved in the interview process for new GP’s.
  • There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 29 September 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.
  • The practice nurses were a Diabetes Specialist Nurse and an Airways (chronic obstructive pulmonary disease and asthma) Specialist Nurse. The diabetes nurse was accessible by telephone on a daily basis for advice and triage of patients. The Breath Easy group for patients and unregistered patients in the locality was established by the Airways nurse.
  • The percentage of patients with diabetes, on the register, who had influenza immunisation in the preceding 1 August to 31 March, was 98% which was comparable to the local and national average of 94%.
  • Longer appointments and home visits were available when needed.
  • All these patients had a named GP and 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 29 September 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 people who had a high number of A&E attendances.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • GP’s told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • The percentage of women aged 25-64 whose notes record that a cervical screening test has been performed in the preceding 5 years (01/04/2014 to 31/03/2015) was 95% which was higher than the CCG average of 87% 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 29 September 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Older people had a dedicated GP for continuity of care; however they were also able to see any GP of their choice.
  • All staff at the practice had training in Dementia care.
  • Quarterly multi-disciplinary meetings were held to discuss the care and treatment needs of complex patients including end of life care.
  • Patients in local residential and nursing homes had a named GP who was solely responsible for their care and treatment.

Working age people (including those recently retired and students)

Good

Updated 29 September 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 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 reflects the needs for this age group. For example, patients were able to book and cancel appointments online, update their contact details, complete a feedback questionnaire, order repeat prescriptions and apply to join the patient participation group.
  • Emergency contraception was available at the practice during all opening hours.

People experiencing poor mental health (including people with dementia)

Good

Updated 29 September 2016

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

  • 87% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was higher than the CCG average of 82% and the national average of 84%.
  • The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a comprehensive, agreed care plan documented in their patient record, in the preceding 12 months (01/04/2014 to 31/03/2015) was 95% which is higher than the CCG average of 86% and the national average of 88%.
  • 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 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 and had completed Dementia care training.

People whose circumstances may make them vulnerable

Good

Updated 29 September 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 homeless people, 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.
  • 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.