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Inspection Summary


Overall summary & rating

Good

Updated 14 January 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Central Medical Centre on 10 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.
  • Most risks to patients were assessed and well managed.
  • 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.
  • Data showed patient outcomes were average or above for the locality. Audits had been carried out with evidence that they were driving performance to improve patient outcomes.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice used innovative and proactive methods to meet patients’ needs, specifically tailoring their services for patients from vulnerable groups.
  • Information about services and how to complain was available and easy to understand and a range of patient information was available in Tamil.
  • Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day. Patients were able to get routine appointments quickly.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Policies and procedures were not always easily accessible for staff but there was evidence that they were updated to reflect changes in practice systems.
  • 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 and they had an active Patient Participation Group (PPG).
  • The provider was aware of and complied with the requirements of the Duty of Candour.

We saw several areas of outstanding practice:

  • The practice had tailored its service and there were innovative approaches to promoting patient education, especially in vulnerable groups. The practice had developed patient education information for a range of conditions in Tamil, including a diabetes book and provided new patient health checks to promote self-management. The practice reported they had shared their information leaflets with other local health services to support Tamil patients.

  • The practice had tailored its services for vulnerable patients; staff were able to speak twelves languages, chaperones that spoke Tamil were available and information was available in Tamil in the patient waiting area including information for bereavement support.

  • The practice had an in-house pharmacist and reviews for patients over 75 were completed jointly by the practice nurse, GP and practice pharmacist where indicated. Joint home visits were undertaken for housebound patients over 75 to complete their care plans, to ensure that patients’ holistic needs were assessed. The pharmacist was involved with ensuring that the medicines that patients from overseas were taking were replaced with appropriate UK equivalents.

The areas where the provider should make improvement are:

  • Ensure that emergency equipment includes access to defibrillator pads for children.
  • Ensure that the practice has a updated record of assessed risks

    relating to health and safety of the premises including those related to

    asbestos and portable appliance testing.

  • Ensure the practice has systems in place to monitor staff training effectively, including mandatory training requirements and ensure that practice policies and procedures are easily accessible for staff.
  • Ensure that minutes are recorded for partnership meetings so actions can be monitored.

  • Consider how to improve patient satisfaction regarding access to appointments as indicated in the GP patient survey.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 14 January 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 although it was not always clear if all actions were followed up.

  • When there are unintended or unexpected safety incidents, people receive reasonable support, truthful information, a verbal and written apology and are 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.

  • Most risks to patients were assessed and well managed.

Effective

Good

Updated 14 January 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality and the practice performed highly in relation to childhood immunisation rates and supporting those with learning disabilities.

  • Staff assessed needs and delivered care in line with current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the knowledge and experience to deliver effective care and treatment and there was a large skill mix amongst clinical staff.

  • There was evidence of appraisals and personal development plans for all staff.

  • Staff worked with multidisciplinary teams on a monthly basis to understand and meet the range and complexity of people’s needs.

Caring

Good

Updated 14 January 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice in line with others for several aspects of care.

  • However, feedback from patients about their care and treatment from comments cards, compliments and patients we spoke with was consistently and strongly positive.

  • All 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 with information about bereavement support available in Tamil.

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

Responsive

Outstanding

Updated 14 January 2016

The practice is rated as outstanding for providing responsive services.

  • It reviewed the needs of its local population and engaged with the Clinical Commissioning Group (CCG) to secure improvements to services where these were identified.

  • The practice had tailored its service and there were innovative approaches to promoting patient education, especially in vulnerable groups. The practice had developed patient education information for a range of conditions in Tamil, including a diabetes book and provided new patient health checks to promote self-management.

  • The practice had tailored its services for vulnerable patients; staff were able to speak twelve languages, chaperones that spoke Tamil were available, information was available in Tamil in the patient waiting area.

  • The practice pharmacist worked closely with the nurses and GPs providing joint visits for over 75s where required and they were involved with ensuring that the medicines that patients from overseas were taking, were replaced with appropriate UK equivalents.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services following feedback from patients, for example, improving telephone access.
  • Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day. Routine appointments were available within 24 hours. However, patients reported that they were sometimes kept waiting when appointments were delayed.
  • People were able access appointments and services in a way and at a time that suited them; the practice offered extended hours three evenings per week and every Saturday morning.
  • 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 the practice responded quickly when issues were raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 14 January 2016

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

  • It 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

  • 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 14 January 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, specifically for patients with diabetes and respiratory conditions.

  • Patients at risk of hospital admission were identified as a priority and were placed on the practice’s avoiding unplanned admissions register.

  • Those with two or more long-term conditions were also placed on a practice register. The practice worked to provide these patients with a care plan.

  • The practice monitored patients with uncontrolled diabetes and provided patient information in Tamil due to the higher prevalence of diabetes in the Asian population.

  • Longer appointments and home visits were available when needed.

  • All these patients had access to a structured annual review to check that their health and medication needs were being met.

  • For those people with the most complex needs, the practice worked with relevant health and care professionals to deliver a multidisciplinary approach to care and there was evidence that these monthly meetings were being used effectively to monitor and improve outcomes for patients.

Families, children and young people

Good

Updated 14 January 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.

  • Data for 2014/15 showed that the practice were the second highest performing practice in the Clinical Commissioning Group (CCG) for the five in one vaccine for those under 12 months, achieving 98%.The practice were the highest performing in the CCG for the pre-school booster, achieving 92% compared with CCG average of 63%, despite the practice having a higher than average number of children under 5 years. The practice promoted uptake by monitoring those who missed immunisations and proactively asked parents and guardians to bring the immunisation records to new patient appointments due to the large number of patients from abroad.

  • 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.

  • Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice provided a winter children’s emergency clinic in 2014 to reduce accident and emergency attendances.

  • The practice offered shared care midwifery services and a midwife visited the practice every two weeks.

  • A full range of family planning services were offered.

  • The practice offered health promotion for this population group including chlamydia screening.

Older people

Good

Updated 14 January 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 including avoiding unplanned admissions care plans and over 75s health checks with a GP, practice nurse and practice pharmacist in the practice or at home for those who were housebound.

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

  • Nationally reported data showed that outcomes for patients for conditions commonly found in older people were above Clinical Commissioning Group (CCG) and national average, for example for those with atrial fibrillation and osteoporosis.

  • The percentage of people aged 65 or over who received a

    seasonal flu vaccination was 65% for 2014/15 and

    63% for 2013/14 which was lower than national average. However, the

    practice had worked to promote uptake via offering a Saturday

    flu clinics.

Working age people (including those recently retired and students)

Good

Updated 14 January 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.

  • Extended hours were offered three evenings a week and patients were able to access Saturday morning appointments.

  • The practice was proactive in offering online services for appointments and prescriptions as well as a full range of health promotion and screening that reflected the needs for this age group.

  • A full range of family planning services were offered.

People experiencing poor mental health (including people with dementia)

Good

Updated 14 January 2016

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

  • 96% of people experiencing poor mental health had received an annual physical health check and 70% of those with dementia had received an annual review.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. Meetings were held twice yearly with local community mental health teams to discuss patients on the register.

  • It had a system in place to follow up patients who had attended accident and emergency (A&E) where they may have been experiencing poor mental health.

  • It was proactive in case finding and diagnosing dementia and had increased incidence of dementia over the past three months.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice hosted a psychological therapy service one day a week and were able to refer patients to this service.

  • Staff had a good understanding of how to support people with mental health needs and dementia.

People whose circumstances may make them vulnerable

Outstanding

Updated 14 January 2016

The practice is rated as outstanding 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, housebound patients, vulnerable adults and children and those with a learning disability.

  • It offered longer appointments for people with a learning disability.

  • It provided annual health checks for people with a learning disability and 100% of 17 eligible patients had received a review. The practice met with the community learning disabilities nurse on an annual basis.

  • One of the non-clinical staff members was able to communicate using sign language.

  • The practice were pro-active in making use of new patient health checks to screen new patients with complex conditions, due to the large number of new patients from abroad and due to the high prevalence of diabetes, especially in their Asian population. They had completed 876 new patient checks in 2014/15.

  • There was significant support available for patients with language barriers. The practice had recognised that the majority of their practice population were from Tamil and Sri Lankan backgrounds. There were notices in Tamil in the waiting area and the website could be viewed in other languages. The practice provided a patient information leaflet in Tamil for new patients and information relating to bereavement support was available in Tamil.

  • Twelve different languages were spoken amongst practice staff including Tamil, but a translation service was available when required. Two non-clinical staff members who spoke Tamil had been specifically trained to be a chaperone for this patient population.

  • The practice had tailored its service to ensure patient education was a priority, especially in vulnerable groups. The practice had worked with its staff to develop a range of patient information leaflets in Tamil. Information including detailed leaflets for diabetes, dementia and breast feeding. The practice reported they had shared their information leaflets with other local health services to support Tamil patients.

  • The practice had a high prevalence of diabetic patients; double the expected prevalence for the practice list size. This was due to a high incidence of diabetes in the Asian population. The practice had published a book about diabetes in Tamil, to specifically target those with a risk of uncontrolled diabetes. The practice had also trialled a Saturday morning education session for Tamil patients for long-terms conditions such as diabetes.

  • The practice were able to signpost patients to a local temple which provided social support, access to Tamil families in the area, and some health education from Tamil speaking consultants in radiology and mental health and other invited speakers.

  • 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.

  • The practice regularly worked with multi-disciplinary teams monthly in the case management of vulnerable people and the practice attended quarterly child protection meetings.

  • The practice held a clinical meeting monthly which included a discussion of patients who had attended Accident and Emergency (A&E), to assist in identifying the most vulnerable patients who had frequent A&E

    attendances.