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Inspection Summary


Overall summary & rating

Good

Updated 5 April 2017

Letter from the Chief Inspector of General Practice

Our previous comprehensive inspection at The Broadshires Health Centre on 26 August 2016 found a breach of regulation relating to the safe provision of services. The overall rating for the practice was good. Specifically, we found the practice to require improvement for provision of safe services. It was good for providing effective, caring, responsive and well-led services. All population groups were rated as good The full comprehensive report on the August 2016 inspection can be found by selecting the ‘all reports’ link for The Broadshires Health Centre on our website at www.cqc.org.uk.

This inspection was a desk-based exercise, accompanied by telephone interviews with four members of staff, carried out on 21 March 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified in our previous inspection on 26 August 2016. This report covers our findings in relation to the requirements and improvements made since our last inspection.

We found the practice had made improvements since our last inspection. The information supplied by the practice, and telephone interviews carried out on 21 March 2017 confirmed the practice was meeting the regulation that had previously been breached. We have amended the rating for this practice to reflect these changes. 

Our key findings were as follows:

  • The provider kept practice specific clinical and operational policies and protocols under review. These were recorded when they were updated. Staff were aware of the location of policies and said they were easy to access.
  • There was an appropriate system in place to record and share the outcomes and learning from significant events. Staff we spoke with were able to identify learning from significant events that had occurred since the last inspection.
  • The procedure for dealing with a break in the cold chain (the procedure for keeping medicines requiring a controlled temperature safe) had been updated. We saw minutes of meetings showed the new procedure had been shared with staff and those we spoke with knew how to manage a break in the cold chain if this occurred.
  • There was a system in place to ensure minutes of staff team and practice meetings were shared with all staff.
  • Nationally reported performance data for 2015/16 showed the practice had increased the number of face to face reviews for patients diagnosed with dementia from 78% to 91%. This was above the clinical commissioning group (CCG) average of 87% and national average of 84%. This had been achieved with the practice only removing 2% of patients from this indicator which was below the CCG average of 5% and national average of 7%.
  • The practice sought patient feedback by various means and acted upon the feedback received. Issues and proposed developments were shared with the online patient participation group (PPG) members. This group were encouraged to comment on practice and local health care developments. A suggestion box was available as well as a comments area on the practice website. The common theme in patient feedback was availability of appointments. The practice undertook a daily review of appointment availability and varied the mix of pre-bookable and on the day appointments to respond to this feedback.
  • Patient feedback to staff and via the patient comments and suggestion box showed that evening appointments were appreciated by patients of working age who found it difficult to attend for appointments during normal working hours. The practice responded by appointing a further GP to undertake evening clinics and funded this by obtaining GP access funds.

The rating for the provision of safe services has been updated based on the findings of this desk-based exercise. The overall rating of good remains unchanged.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 April 2017

The practice had taken appropriate action and is now rated as good for the provision of safe services.

At our inspection of 26 August 2016 we found the practice had breached a regulation relating to safe care and treatment that resulted in the rating of requires improvement.

Using information supplied by the practice for this desk top review and by conducting telephone interviews with staff, we saw the previous breach of regulation had been addressed:

  • The practice had updated the policy for maintaining medicines and vaccines at controlled temperatures. The revised policy had been shared with relevant staff.

  • Staff demonstrated a clear understanding of how to maintain medicines that required storage at controlled temperatures and knew what to do if medicine fridge temperatures operated outside of the recommended temperature range.
  • An effective system to record, review and share learning from significant events had been introduced. Staff demonstrated a clear understanding of how to report and respond to a significant event. Records showed that outcomes and learning from significant events were widely shared with the staff team.

Effective

Good

Updated 14 October 2016

The practice is rated as good for providing effective services.

  • Our findings at inspection showed that systems were in place to ensure that all clinicians were up to date with both National Institute for Health and Care Excellence (NICE) guidelines and other locally agreed guidelines.

  • We also saw evidence to confirm that the practice used these guidelines to positively influence and improve practice and outcomes for patients.

  • Data showed that the practice was performing highly when compared to practices nationally. In 2014/15 it had achieved 100% of the national QOF indicators for care of patients with a specific range of diseases. This was above the CCG average of 97% and national average of 95%.

  • The practice was active in undertaking clinical research and this drove improvement in patient care. For example, research had improved the early diagnosis of a specific type of skin cancer.

  • Clinical audits demonstrated quality improvement. These were limited in number due to the focus on research projects. For example, there were seven research projects completed, underway or planned in 2016.

  • 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 14 October 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed 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.

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

Responsive

Good

Updated 14 October 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, it worked with the medicines management team on the quality improvement plan for prescribing. Data showed the practice to be the top performer within Oxfordshire for prescribing anti-coagulant treatment for patients who had a stroke (Anti-coagulant medicines keep the blood thin to improve circulation).

  • Patients said they found it easy to make an appointment with a named GP, within a week of their request, and 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.

  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised.

Well-led

Good

Updated 14 October 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 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. 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

  • There was a focus on continuous learning and improvement at all levels.

  • The practice had a number of policies and procedures to govern activity, but some of these were overdue a review. These policies were not always easy to access by staff. Important information staff required to discharge their duties to patients were held in two different locations.

  • The practice had not optimised opportunities to obtain feedback or support from their PPG.

Checks on specific services

People with long term conditions

Good

Updated 14 October 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 had achieved 100% of the national indicators for treating patients with diabetes compared to the CCG average of 93% and national average of 89%.

  • 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.

  • Nursing staff maintained up to date training to support patients with long term conditions. For example, a member of the nursing team had attended a course on managing patients with a type of chronic lung disease. The learning was being shared with other nurses in the team.

Families, children and young people

Good

Updated 14 October 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.

  • Patients told us that children and young patients were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

  • The practice rate of take up of cervical cancer screening was 89% which was better than the CCG average of 83% and 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 14 October 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 patients in its population.

  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.

  • Nationally reported data showed outcomes in the care of older patients were at or above average. For example, 92% of patients who had a stroke or ‘mini stroke’ received further investigations within three months compared to the CCG average of 89% and national average of 88%.

  • There were 67 patients registered with the practice who lived at a local care home. These patients were screened for early signs of dementia and their care was reviewed if they were admitted to hospital at any time. The practice undertook weekly visits to the care home.

Working age people (including those recently retired and students)

Good

Updated 14 October 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 commenced offering extended hours clinics in June 2013. These appointments, on Tuesday evening each week, assisted patients who found it difficult to attend during normal working hours.

  • The practice offered a range of health promotion opportunities, a total of 41 patients had attended for smoking cessation advice in the last year and 18 of these had stopped smoking.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 October 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 average. For example the practice result for having an agreed care plan in place for patients with severe and enduring mental health problems was 98% compared to the CCG average of 89% and national average of 88%.

  • 78% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was below the national average of 84%. However the percentage of patients excluded from this indicator was 6% compared to the national average of 8%.

  • 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.

People whose circumstances may make them vulnerable

Good

Updated 14 October 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 and those with a learning disability. The practice had completed annual health checks for 81% of patients over the age of 18 with a learning disability.

  • The practice offered longer appointments for patients with a learning disability.

  • 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. They had access to information about how to contact relevant agencies in normal working hours and out of hours.