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Archived: Chickenley Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 25 February 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Chickenley Medical Centre on 26 November 2015. 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.

  • Although risks to patients who used services were assessed, some of the the systems and processes to address these risks were not implemented well enough to ensure patients were kept safe. For example, cleanliness, waste segregation and dealing with medical emergencies.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had 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.
  • Patients said they found it easy to make an appointment with a named GP and that 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.
  • 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.

We saw one area of outstanding practice

The practice had an innovative system in place to monitor and review patients with long term conditions, in particular diabetes. We saw evidence that the practice engaged strongly with other healthcare professionals and the wider community in education of diabetes and other long term conditions.

The areas where the provider should make improvement are:

  • Ensure premises and equipment are maintained and cleaned in line with current legislation and guidance.
  • Ensure domestic, clinical and hazardous waste and materials are managed and disposed of in line with current legislation and guidance.

  • To have a process in place for undertaking criminal record checks at the appropriate level (only for staff who require a check) and assess the different responsibilities and activities of staff to determine if they are eligible for a DBS check and to what level.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 February 2016

The practice is rated as requires improvement for providing safe services.

  • There was an effective system in place for reporting and recording significant events.
  • Emergency drugs and equipment were available however the arrangements for the management of emergency medicines had not been appropriately risk assessed. Immediate action was taken by the practice to risk assess the arrangements for accessing emergency medicines.
  • Infection prevention and control policies and procedures were in place. However, we saw that some areas of the premises and equipment were not clean. Standards of cleanliness were not sufficiently monitored. The practice took immediate action to address this.
  • Waste management policies and procedures were in place for domestic, clinical and hazardous waste. However, we saw evidence that these were not being followed. The practice took immediate action to ensure all staff were disposing of waste correctly.
  • Lessons were shared to make sure action was taken to improve safety in the practice.
  • When there were unintended or unexpected safety incidents, people received reasonable support, truthful information, a verbal and written apology and 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 keep people safe and safeguarded from abuse.
  • DBS checks had not been carried out on staff other than the GPs.

Effective

Good

Updated 25 February 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated improvements.
  • There were effective systems in place for reviewing patients with long term conditions, particularly diabetes where the practice made innovative use of online resources to manage and improve care. Staff engaged with other professionals and the community.
  • 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 people’s needs.

Caring

Good

Updated 25 February 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice higher than others for several aspects of care.
  • Patients said 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.

Responsive

Good

Updated 25 February 2016

The practice is rated as good for providing responsive services.

  • It 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.
  • There were innovative approaches to engaging with the local community. For example, presenting health programmes on the community radio station and working with the Indian Muslim Welfare Society.
  • Patients said they found it easy to make an appointment with a named GP and that there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities which were well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed that the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 25 February 2016

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

  • It had a vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about their responsibilities in relation to this.
  • 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. Although regular monitoring of cleanliness and infection prevention & control had lapsed the practice took immediate action to review systems and responsibilities for the monitoring of cleanliness.
  • 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 knowing about notifiable safety incidents.
  • The practice proactively sought feedback from staff and patients, which it acted on. The virtual patient participation group (PPG) was active and communicated via email.
  • There was a strong focus on continuous learning and improvement at all levels.
  • The practice and PPG had carried out it’s own survey of patients in 2015.
Checks on specific services

People with long term conditions

Outstanding

Updated 25 February 2016

The practice is rated as outstanding 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.
  • Six per cent of the patient list had diabetes and the GPs and nurses worked closely with local groups to educate the community about this condition.
  • The diabetic lead for the practice was involved with the local diabetes network and made use of e-consultations with the diabetes specialist consultant. One hundred per cent of patients newly diagnosed with diabetes, on the register, in the preceding 1 April to 31 March had a record of being referred to a structured education programme within nine months after entry on to the diabetes register which was above the CCG and England average of 90%.
  • The practice provided an in house Spirometry service for chronic obstructive pulmonary disease (COPD). Ninety five per cent of patients with COPD (diagnosed on or after 1 April 2011) had their diagnosis confirmed by post bronchodilator spirometry between three months before and 12 months after entering on to the register compared to the CCG average of 92% and the national average of 90%.
  • Longer appointments and home visits were available when needed.
  • All these patients 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.
  • A nurse and healthcare assistant provided combined well person check clinics.
  • All patients on any medication were reviewed every six to eight months by a doctor to reauthorize future repeat prescriptions. At theses reviews opportunistic disease management  checks and health promotion were carried out.
  • A board for palliative care patients which was updated daily to ensure staff provided holistic care to patients and their families/carers was introduced in response to an incident..

Families, children and young people

Good

Updated 25 February 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 accident and emergency (A&E) attendances. Immunisation uptake rates were relatively high for all standard childhood immunisations.
  • Patients and staff told us that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The percentage of women whose notes recorded that a cervical screening test had been performed in the preceding five years was 81% which was comparable to CCG and England averages.
  • Same day appointments were always available for young children who were unwell.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 25 February 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.
  • It was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Staff liaised with district nurses, the community matron and social care staff, especially for housebound patients.
  • The practice followed the gold standard framework for all people nearing the end of life.
  • The practice worked with a local community provider to triage and assess calls from local nursing homes to reduce unplanned hospital admissions
  • The building was purpose built with level access and all services at ground floor level.

Working age people (including those recently retired and students)

Good

Updated 25 February 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.
  • The practice offered appointments on a Monday evening until 8.00pm at the Grove House surgery for working patients who could not attend during normal opening hours.
  • Appointment availability was regularly reviewed to support access to the service.

People experiencing poor mental health (including people with dementia)

Good

Updated 25 February 2016

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

  • Seventy four per cent of people diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.
  • It 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.
  • It 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 people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 25 February 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.
  • It offered longer appointments for people with a learning disability.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • It 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.