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The Merton Medical Practice Good

Inspection Summary


Overall summary & rating

Good

Updated 12 May 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at The Merton Medical Practice on 23 February 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.
  • Most risks to patients were assessed and well managed with the exception of some health and safety risks.
  • 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 an area of outstanding practice:

  • Performance for mental health related indicators was above the Clinical Commissioning Group (CCG) and national averages; 98% of patients had received an annual review compared with CCG average of 92% and national average of 88%.The number of patients with dementia who had received annual reviews was 100% which was above the CCG average of 84% and national average of 84%. The practice ensured that they worked with patients to improve their dementia diagnosis rate. Data from October 2014 showed that the practice’s dementia diagnosis rate was over 70% which was the second highest achievement in the CCG.

The areas where the provider should make improvement are:

  • Ensure there is a robust system in place to store, track and monitor the use of prescription pads throughout the practice.

  • Ensure that action plans from infection control audits include all identified risks.

  • Ensure that the practice has effective health and safety systems in place for equipment testing, health and safety risk assessments, the control of substances hazardous to health (COSHH) and Legionella risk.

  • Consider installing a hearing loop.

  • Review and improve telephone access for patients.

  • Ensure that complaints are acknowledged in a timely way, in line with the practice’s complaint handling policy.

  • Consider the use of patient surveys as a method for gathering targeted patient feedback to assist in improving the quality of the service.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 May 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 there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and 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 keep patients safe and safeguarded from abuse.
  • Most risks to patients were assessed and well managed, with the exception of some health and safety risks.

Effective

Good

Updated 12 May 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed that the majority of patient outcomes were above average for the locality and compared to the national average.
  • The practice had a clear awareness of their clinical performance and monitored patients effectively.
  • 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 multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 12 May 2016

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed mixed responses; however the majority of patients rated the practice higher than others for several aspects of care.

  • Patients told us they were happy with the high standard of care received. They felt they treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.

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

  • Information for patients about the services available was easy to understand and accessible.

Responsive

Good

Updated 12 May 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. For example, the practice provided a phlebotomy service every week day morning for practice patients.
  • The practice had offered a range of appointment options to improve access to appointments for their patients.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day, however some patients reported difficulty in getting through on the 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 to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 12 May 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 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.
  • 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 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 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 12 May 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.
  • Performance for diabetes related indicators was above Clinical Commissioning Group (CCG) and national averages. For example, 85% of patients had well-controlled diabetes, indicated by specific blood test results, compared to the CCG average of 73% and the national average of 78%.
  • Flu vaccination rates for 2014/15 for patients with diabetes was 97%. This was above the CCG and national averages.
  • Longer appointments and home visits were available when needed.
  • The practice provided a phlebotomy service every weekday morning with a health care assistant.
  • The practice provided a fortnightly clinic for patients with diabetes and chronic obstructive pulmonary disease (COPD).
  • 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.
  • The practice was signed up to the national avoiding unplanned admissions enhanced service, to identify those vulnerable patients most at risk of admission to hospital and they were also signed up to a local service to identify those at risk with two or more long-term conditions. The practice used these registers of patients to ensure that patients were able to access care and treatment in a timely way.

Families, children and young people

Good

Updated 12 May 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.
  • Patients 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 patients diagnosed with asthma, on the register, who had an asthma review in the last 12 months was 88% which was higher than national average of 75%.
  • Childhood immunisation rates for the vaccinations given were above or line with Clinical Commissioning Group (CCG) averages for 2014/15.
  • The practice provided postnatal care and chlamydia screening and a range of contraceptive services were provided by GPs and the practice nurse.
  • The practice’s uptake for the cervical screening programme was 86%, which was above the CCG average of 83% and the national average of 82%.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.

Older people

Good

Updated 12 May 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.
  • Data showed that outcomes for patients for conditions commonly found in older people were above local and national averages.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice provided a weekly session in a local sheltered accommodation, working closely with the warden to ensure patients’ needs were met.
  • The percentage of people aged 65 or over who received a seasonal flu vaccination was 78% which was above the national average.

Working age people (including those recently retired and students)

Good

Updated 12 May 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 reflected the needs for this age group.
  • Extended hours surgeries were offered four evenings per week.
  • Patients were able to receive travel vaccinations available on the NHS and they were a registered yellow fever centre.
  • Smoking cessation was provided in-house by a health care assistant.
  • The practice provided a phlebotomy service every weekday morning with a health care assistant.
  • The practice provided NHS health checks for people aged 40–74. In 2014/15, the practice had achieved more than their Clinical Commissioning Group (CCG) target of 141, by undertaking 188 NHS health checks with a health care assistant.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 May 2016

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

  • Performance for mental health related indicators was above the Clinical Commissioning Group (CCG) and national averages; 98% of patients had received an annual review compared with CCG average of 92% and national average of 88%.
  • The number of patients with dementia who had received annual reviews was 100% which was above the CCG average of 84% and national average of 84%. The practice ensured that they worked with patients to improve their dementia diagnosis rate. Data from October 2014 showed that the practice’s dementia diagnosis rate was over 70% which was the second highest achievement in the CCG.
  • The practice provided special arrangements for a local home for patients with severe mental illness; providing an annual visit by a GP to ensure patients received an annual physical health check or inviting patients and the carers to the practice.
  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The GPs met with a consultant psychiatrist every two months to discuss practice patients receiving community mental health services.
  • 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 12 May 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, carers and those with a learning disability as well as a register of those most at risk of admission to hospital.
  • The practice were not signed up to the incentivised enhanced service to offer physical health checks to those patients with learning disabilities, however they had still ensured that these patients were monitored effectively and had completed 15 reviews out of 16 patients on the register which was 94%.
  • The practice offered longer appointments for patients with a learning disability.
  • Flu vaccination rates for 2014/15 for at risk groups was 58%. This was above the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • 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.