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Inspection Summary


Overall summary & rating

Good

Updated 2 May 2018

This practice is rated as Good overall. (Previous inspection March 2017 – Good)

We carried out an announced comprehensive inspection on at Gorton Medical Centre on 27 March 2017. The overall rating for the practice was good with key question Well Led rated as requires improvement. At that inspection we found improvements were needed in the practice systems for the monitoring of incidents and significant events, and where learning and improvement were identified these were not always shared effectively. We issued a requirement notice in respect of good governance, as further improvements were required We identified other areas of improvement including undertaking full cycle clinical audits and monitoring and sharing patient safety alerts as part of the practice’s quality improvement programme and listening to patient feedback, developing the patient participation group and maintaining a carer’s register.

The full comprehensive report on the March 2017 inspection can be found by selecting the ‘all reports’ link for Gorton Medical Centre on our website at www.cqc.org.uk

This inspection was a focused visit to the practice on 4 April 2018 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 27 March 2017. This report covers our findings in relation to those requirements and additional improvements made since our last inspection.

This focused inspection visit identified improvements had been made in service delivery for key question Well Led and this is now rated good.

Our key findings were as follows:

•At our previous inspection in March 2017 we found some records of significant event investigations did not contain all the required information and evidence that the findings from investigations was shared with staff was limited. At this inspection visit, both practice full team meeting and clinical meeting minutes showed the significant events were discussed and evidence was available to demonstrate improvements were made and learning from these was shared.

•Since the previous inspection, the practice had reviewed how it ensured patient safety alerts were shared with the staff team and had introduced a system to ensure these were acted upon as required.

•The practice had introduced a range of clinical searches on a variety of patient health care conditions. These searches were allocated to GPs who undertook relevant clinical audit and re-audit to evaluate the effectiveness of the actions the practice had implemented to improve patient outcomes.

•The practice had introduced a carer’s information pack and referral process. It had made some headway in building a carer’s register. However there were still low numbers of patients’ identified as carer’s.

•The practice had implemented a patient survey and initial results had indicated patients were satisfied with the service. The practice manager had identified areas requiring action as a result of patient feedback.

•The practice continued to promote their patient participation group and held regular practice meetings

The areas where the provider should make improvements are:

Continue to develop the practice carer’s register and the patient participation group.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Effective

Good

Caring

Good

Responsive

Good

Well-led

Good

Updated 2 May 2018

We rated the practice and all of the population groups as good for providing a well-led service.

At our previous inspection on 27 March 2017, we rated the practice as requires improvement for providing well led services as the systems for monitoring, learning and improving from significant events and incidents and sharing this learning within the staff required improvement.

In addition, we identified other areas requiring improvement. There were no effective systems of clinical audit and review and evidence of responding to patient safety alerts. Records and information to support patients who were carers and processes for responding to patient feedback needed further development.

These arrangements had improved when we undertook a focused inspection on 4 April 2018.

The practice is now rated as good for providing well led services.

Governance arrangements

Systems to demonstrate clear roles, responsibilities, and accountability to support good governance and management had improved. For example:

•At our previous inspection in March 2017 we found some records of significant event investigations did not contain all the required information and evidence that the findings from investigations was shared with staff was limited. At this inspection visit, both practice full team meeting and clinical meeting minutes showed the significant events were discussed with the staff team.

•Clinical team meeting minutes showed that the recording form for significant events had been discussed and one format agreed in line with the practice’s significant event analysis protocol. Evidence was available that the GPs had retrospectively reviewed recent significant events to ensure the recording of information was standardised and the content and outcome were clearly recorded. The practice manager confirmed that significant events were a standing agenda item for each practice meeting and we heard the practice planned to continue the retrospective review of significant events to ensure completion and evidence of shared learning. The full practice team meeting minutes also demonstrated that significant events were discussed with the whole team.

•At our previous inspection we noted that the practice was unable to demonstrate that patient safety alerts were responded to appropriately. We observed at this inspection that the practice had a patient safety alert protocol and procedure available and this identified the practice manager and the assistant practice manager as being responsible for monitoring received alerts and disseminating these to the practice team. A paper copy of the alert was maintained in the reception area and an electronic record held on the practice’s document management system.

•The lead GP reviewed the patient safety alerts and working with the practice pharmacist, these were responded to as required. For example, following receipt of a recent alert regarding asthma inhalers the practice had reviewed those patients prescribed this inhaler and contacted to ensure the issue did not affect them.

•Our previous inspection identified that a programme of a planned quality improvement including clinical audit and re-audit was not implemented effectively. This inspection identified the practice had undertaken a range of different clinical searches and implemented action to improve the clinical outcomes for patients. Evidence available demonstrated the clinical reviews were audited, re-audited and evaluated for effectiveness. Team meeting minutes recorded the clinicians responsible for the clinical audits and follow up re-audits. Recent clinical audit included reviewing the treatment delivered to patients with Chronic Obstructive Pulmonary Disease (COPD) and smoking, COPD and body mass index (BMI) and female patients of child bearing age with epilepsy.

•The practice had introduced a carer’s policy and a carer’s information and referral pack since the previous inspection in March 2017. At the time of this visit, the practice had 46 patients also registered as carers. This represented just over 0.5% of the patient population. The practice manager stated they continued to try to identify patients who were carer’s.

•The practice continued to promote their patient participation group (PPG) and there were minutes available from recent meetings. The practice was also implementing a patient survey. The initial results indicated patients were generally satisfied with the service provided. The practice manager had identified one area that indicated patients’ required clarification around the role of the duty doctor for on the day urgent appointments, in that the duty doctor was not a GP of patient choice.

Checks on specific services

People with long term conditions

Good

Updated 6 June 2017

The provider was rated as good for this population group.

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.
  • 71% of patients with diabetes, on the register, who had IFCCHbA1c of 64 mmol/mol or less in the preceding 12 months (01/04/2015 to 31/03/2016) compared to the CCG and national average of 75% and 78% respectively.

  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.

  • There were emergency processes for patients with long-term conditions who experienced a sudden deterioration in health.
  • All these patients had a named GP and there was a system to recall patients for 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 6 June 2017

The provider was rated as good for this population group.

  • From the sample of documented examples we reviewed we found there were systems 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 rates were relatively high for all standard childhood immunisations.
  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • Appointments were available outside of school hours and the premises were suitable for children and babies.
  • The practice worked with midwives, health visitors and school nurses to support this population group.
  • The practice’s uptake for the cervical screening programme was 83% (2015/2016), which was better than the CCG average of 78% and the national average of 81%.

Older people

Good

Updated 6 June 2017

The provider was rated as good for this population group.

  • Staff were able to recognise the signs of abuse in older patients and described the process for how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. The practice participated in the nursing home project and worked closely with a local nursing home with the aim of minimising unnecessary hospital admissions.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice identified at an early stage older patients who may need palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.
  • The practice followed up on older patients discharged from hospital and ensured that their care plans were updated to reflect any extra needs.
  • Where older patients had complex needs, the practice shared summary care records with local care services. For example; district nurses and social and health care partners involved with the nursing home project.
  • Older patients were provided with health promotional advice and support to help them to maintain their health and independence for as long as possible such as; healthy eating and keeping active.

Working age people (including those recently retired and students)

Good

Updated 6 June 2017

The provider was rated as good for this population group.

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care, for example, extended opening hours and Saturday appointments.
  • 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.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 June 2017

The provider was rated as good for this population group.

  • The practice carried out advance care planning for patients living with dementia.
  • 69% of patients diagnosed with dementia whom had their care reviewed in a face to face meeting in the last 12 months, which was below the CCG and national average 89% and 84% respectively.
  • The practice specifically considered the physical health needs of patients with poor mental health and dementia. For example a nominated GP from the practice visited a local residential home twice a week.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • 76% of patients with schizophrenia, bipolar affective disorder and other psychoses whose alcohol consumption had been recorded in the preceding 12 months (01/04/2015 to 31/03/2016) which was lower than the CCG and national average of 89% and 89% respectively.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Patients at risk of dementia were identified and offered an assessment.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.
  • The practice had a system to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff interviewed had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 6 June 2017

The provider was rated as good for this population group.

  • The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • 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 had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They 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.