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Colchester Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 22 June 2017

Letter from the Chief Inspector of General Practice

On 12th December 2016 we carried out a comprehensive announced inspection at Colchester Medical Practice. We rated the practice as good overall and good for providing effective, caring, responsive and well-led services. We rated the practice as requires improvement for providing safe services and a requirement notice was served. This was because there was not a clear system in place to monitor patients taking high risk medicines.

We identified that there were two areas where the practice should make improvements: we advised that the provider should implement a system to review the health care needs of patients who did not collect their prescriptions and further, in the caring key question, we advised that the provider should offer a carer’s health check.

The full comprehensive report on the December 2016 inspection can be found by selecting the ‘all reports’ link for Colchester Medical Practice on our website at www.cqc.org.uk.

This inspection was a desk-based review carried out on 12th June 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 12th December 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice continues to be rated as good and safe is now rated as good.

Our key findings were as follows:

  • Patients taking high-risk medicines are now monitored through a system of audit, recall and regular checks.
  • There were measures in place to identify patients who had not collected their repeat prescriptions.
  • Although the provider did not offer a routine carer’s healthcheck, carers were identified on the practice computer systems and referred to the Care Advisor for support and advice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 22 June 2017

At our inspection of 12th December 2016, the practice was rated as requires improvement for providing safe services. It is now rated as good.

  • At our inspection in December 2016, we found improvements were required to ensure that patients taking high risk medicines were effectively reviewed before a repeat prescription was authorised.
  • Systems were now in place to audit, identify and recall patients who took high risk medicines and needed blood tests.
  • The practice now monitored uncollected prescriptions.

Effective

Good

Updated 26 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or 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 for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.
  • Patients could be directed to GPs working in the other branch surgeries who had special interests or additional qualifications, for example in relation to gynaecology or dermatology.
  • Clinical staff had additional training and qualifications to meet patients’ health needs.

Caring

Good

Updated 26 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice in line with 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.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The reception area had been refurbished so that the reception desk allowed for more confidential discussions.

Responsive

Good

Updated 26 January 2017

The practice is rated as good for providing responsive services.

  • Open access appointments were available every weekday morning for patients who presented at the practice without a pre-booked appointment.
  • Later appointments were available from 6.30pm until 7.30pm on a Tuesday and Wednesday and earlier at 7am until 8am on a Thursday.
  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they meet patients’ needs. A counsellor, midwife, ultrasound, audiologist and care advisor held regular clinics at the practice.
  • Patients could pre-book to have their bloods tested every week day between 8.20am and 2.30pm.
  • Appointment reminders could be sent by text message to patients providing their mobile phone number.
  • 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.

Well-led

Good

Updated 26 January 2017

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.
  • 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.
  • The practice proactively sought feedback from staff and patients, which it acted on. The patient participation group was active.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 26 January 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.
  • There were monthly multi-disciplinary meetings with other healthcare professionals to discuss complex patients.
  • Performance for diabetes indicators was in line with local and national averages. The percentage of patients with diabetes whose cholesterol was within specified limits was 73%, which was 1% above CCG average and 3% above England average.
  • The practice carried out a monthly audit of patients taking a certain medicine to thin their blood to check that they had appropriate monitoring; however, the procedures to monitor patients on other high-risk medicines were not effective.

Families, children and young people

Good

Updated 26 January 2017

The practice is rated as good for the care of families, children and young people.

  • The midwife held a regular clinic at the practice on a Monday afternoon.
  • There were appointments available out of school hours.
  • The practice carried out antenatal and postnatal checks. There was a monthly audit completed to identify mothers who had given birth and not yet presented for their six week check-up.
  • A full contraceptive service was available including advice about pills, caps, implants, sheaths and coils.The practice carried out a monthly audit of patients who had not presented for their six week check-up following a coil fitting. The patients were then contacted and invited to attend at the practice.
  • The percentage of patients aged 8 or over with asthma with measures of variability or reversibility recorded between 3 months before or any time after diagnosis was in line with local and England average.
  • Childhood immunisation rates for the vaccinations given were comparable to CCG and national averages. Childhood immunisation rates for the vaccinations given to under two year olds ranged from 92% to 94% and five year olds from 86% to 93%.

Older people

Good

Updated 26 January 2017

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

  • All patients who were aged 75 years and over were offered an annual health check and a flu vaccination.
  • The practice completed a monthly audit to ascertain patients who were approaching their 75th birthday, or newly registered patients who were aged over 75. Once identified, patients were contacted to advise them of their named GP.
  • There was a monthly audit of patients aged over 90 and in care homes, which sought to ensure that older patients had been identified on all relevant registers.

  • The practice offered home visits and a number of in house services, such as phlebotomy and audiology, so that the practice was responsive to the needs of older people.
  • Older patients at risk of attending as unplanned admissions into hospital were identified and had care plans in place to address their needs.
  • The advance nurse practitioner attended at two local care homes on a weekly basis to provide care and treatment. We spoke with representatives of these two care homes who told us that they were always able to get an appointment when they needed one and that patients were regularly reviewed.

Working age people (including those recently retired and students)

Good

Updated 26 January 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.
  • Data for the year 2015/2016 showed that 78% of females aged 25-64 had attended for their cervical screening which was in line with the local and national averages.
  • Open access appointments were available every weekday morning for patients who presented at the practice without a pre-booked appointment.
  • Later appointments were available from 6.30pm until 7.30pm on a Tuesday and earlier at 7am until 8am on a Thursday.
  • A counsellor, midwife, audiologist and care advisor held regular clinics at the practice.
  • Patients could pre-book to have their bloods tested every week day between 8.20am and 2.30pm.
  • Appointment reminders could be sent by text message to patients providing their mobile phone number.

People experiencing poor mental health (including people with dementia)

Good

Updated 26 January 2017

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

  • The percentage of patients diagnosed with dementia whose care had been reviewed in a face-to face review in the preceding 12 months was 97% which was higher than the local by 20% and above CCG average, by 19%.
  • Performance for mental health indicators was higher than local and national averages. The percentage of patients with schizophrenia, bipolar affective disorder and other psychoses who had a care plan documented in the record in the 12 months was 93%, which was 17% above the local average and 15% above the England average.
  • There was a weekly clinic held by the counsellor.
  • A representative of a local care home told us the GPs and advanced nurse practitioner was accessible and approachable to patients with dementia.

People whose circumstances may make them vulnerable

Good

Updated 26 January 2017

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

  • The practice had identified 955 patients as carers, which amounted to 3.85% of the practice list.
  • Relevant patients were invited to identify themselves as carers so that they could be supported appropriately during their consultations and invited for a flu vaccine.
  • There were 34 patients on the learning disabilities register and 14 patients had received a routine health check in the current year, which ends April 2017.
  • 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.
  • The practice worked closely with a women’s refuge. A nurse who worked at the practice had achieved a diploma in domestic violence and was trained to safeguarding level eight.
  • A GP care advisor was available at the practice to advise patients on obtaining benefits and extra support.
  • The practice worked with a local organisation to provide support and treatment for patients who were homeless or with drug dependency issues.
  • The practice actively monitored temporary patients which sought to ensure that they presented for their routine health checks.