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Inspection Summary


Overall summary & rating

Good

Updated 28 May 2015

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at the Ruddington Medical Centre on 09 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring, responsive and well-led services. It was also good for providing services for all the population groups we inspected.

Our key findings across all the areas we inspected were as follows:

  • Risks to patients were mostly assessed and well managed. However, recording systems in respect of the management of the practice and staff employed needed strengthening to ensure a safe service. This included infection control policies, procedures for dealing with emergencies and staff records.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Most patients said they found it easy to make an appointment and urgent appointments were usually available the same day. Some patients felt improvements were required in respect of the availability of non-urgent appointments, in particular if they wished to see a specific GP or outside working hours.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance.
  • Staff had received training appropriate to their roles and any further training needs had been identified and planned.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about services and how to complain was available and easy to understand.
  • There was a clear leadership structure and staff felt supported by management.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the Patient Participation Group (PPG).
  • There were high levels of engagement between the practice and patient participation group (PPG) to encourage: patients to be more proactive in managing their conditions; provide information and support for carers; and ensure the regular review of services.

However there were areas of practice where the provider needs to make improvements.

The provider should:

  • Improve the availability of non-urgent appointments and flexibility of access to appointments for the working age population group.
  • Ensure recruitment arrangements include all necessary employment checks for all staff.
  • Ensure all staff have appropriate policies and guidance to carry out their roles in a safe manner.
  • Ensure systems for assessing, monitoring and recording risks and the quality of the service provision are strengthened.
  • Ensure an up to date business plan is in place and discussed with all staff.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 28 May 2015

The practice is rated as good for providing safe services.

Most of the risks to patients and staff were assessed. The recording and processes to address these risks needed strengthening to ensure people were kept safe. This included infection control, health and safety, recruitment and management of unforeseen circumstances / emergencies.

Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Lessons were learned and communicated widely to support improvement.

We found appropriate systems were in place to ensure patients were safeguarded from abuse, equipment was safely maintained and the management of medicines. There were enough staff to keep patients safe.

Effective

Good

Updated 28 May 2015

The practice is rated as good for providing effective services.

Patient’s needs were assessed and care was planned and delivered in line with current legislation. This included assessing capacity and promoting good health. Staff referred to guidance from National Institute for Health and Care Excellence (NICE) and used it routinely in their assessments.

Data reviewed showed most patient outcomes were in line or above average when compared to neighbouring practices in the Clinical Commissioning Group. Clinical audits were carried out to monitor and improve the care and outcomes for patients.

Staff worked with other health and social care professionals to improve patient outcomes. Regular multi-disciplinary meetings were held and the practice had identified the need to improve the recording of discussions and agreed actions.

Staff had received training appropriate to their roles and any further training needs had been identified and planned for to meet these needs. There was evidence of appraisals and personal development plans for staff.

Effective systems were in place in respect of information sharing with other services and promoting health promotion and prevention.

Caring

Good

Updated 28 May 2015

The practice is rated as good for providing caring services.

Patients told us they were treated with compassion, dignity and respect. They described staff as being friendly, caring and helpful. This was reflected in the data we looked at which showed positive patient feedback in relation to involvement in decisions about their care and treatment.

The practice had good systems in place to support carers and patients to cope emotionally with their health and condition. Information to help patients understand the services available was easy to understand.

We saw that staff were respectful and polite when dealing with patients, and maintained confidentiality. They were able to give positive examples to demonstrate how patient’s choices and preferences were valued and acted on. Views of external stakeholders such as care home managers were positive and aligned with our findings.

Responsive

Good

Updated 28 May 2015

The practice is rated as good for providing responsive services.

Most patients were generally satisfied with the appointment system and confirmed being able to see a doctor and / or nurse when needed. Some patients reported access to a named GP and continuity of care was not always available quickly, although urgent appointments were usually available the same day.

Improving phone access and the appointment system was a priority area for the practice. The practice acted on suggestions for improvements and changed the way it delivered services in response to feedback from the patient participation group (PPG).

The practice reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group (CCG) to secure service improvements where these had been identified. The practice worked in liaison with other health social care professionals to ensure patients’ received care and treatment when needed.

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 that the practice responded appropriately to issues raised. Learning from complaints was shared with staff and other stakeholders to improve the service.

Well-led

Good

Updated 28 May 2015

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

The practice had a vision in place and staff were committed to improving the quality of care and services for patients. The strategy to deliver this vision was being reviewed in response to staff changes and patient feedback. There was a clear leadership structure and staff felt supported and valued by management.

The practice had a number of policies and procedures to govern activity and held regular governance meetings. There were systems in place to monitor and improve quality and identify risk. Staff received inductions, performance reviews and attended staff meetings and events. These governance arrangements needed strengthening to ensure the practice continued to provide high standards of service.

The patient participation group (PPG) was very active and there was a high level of constructive engagement with the practice staff to improve patient outcomes and the delivery of service. This was an outstanding feature for the practice.

Checks on specific services

Older people

Good

Updated 28 May 2015

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

Patients aged 75 years and over were allocated a named GP to provide continuity of care. The practice offered personalised care to meet the needs of older people including a range of enhanced services, for example in dementia and end of life care. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people.

The GPs worked closely with the community matron and geriatrician to assess older people’s care needs and plan the delivery of their care. Annual health checks including flu vaccinations were offered and referrals were made to services such as the falls team to reduce the risk of falls.

The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs. Weekly nursing home visits were undertaken, and this was acknowledged positively in feedback received from two care home managers. Carers were identified and supported to care for older people.

People with long term conditions

Good

Updated 28 May 2015

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. Appropriate care plans were put in place to support patients’ care needs and enable them to remain at home, where possible.

For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. All these patients had a structured annual review to check that their health and medication needs were being met.

Longer appointments and home visits were available when needed. Nationally reported data showed that outcomes for patients with long term conditions were good. Emergency processes were in place and referrals were made for patients who had a sudden deterioration in health.

Families, children and young people

Good

Updated 28 May 2015

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

The practice prioritised appointment requests for children and young people. Patients we spoke with and comment cards received confirmed same day appointments for children were provided. Appointments were available outside of school hours and the premises were suitable for children and babies.

The practice offered immunisation services for children and young people as well as family planning services. Immunisation rates were relatively high for all standard childhood immunisations.

We saw good examples of joint working with health visitors and midwives. This included monthly multi-disciplinary meetings to discuss concerns relating to specific families and / or children; and ways to support them and ensure their safety.

There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk of abuse. Staff had received relevant training on safeguarding vulnerable children and adults; and knew how to respond to signs of abuse.

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.

Working age people (including those recently retired and students)

Good

Updated 28 May 2015

The practice is rated as good for the care of working-age people (including those recently retired and students).

The practice had adjusted most of the services it offered to ensure they were accessible and flexible to meet the needs of this population group. Patients could access telephone consultations and online services for ordering repeat prescriptions and booking appointments. Patient feedback showed most people were happy with the appointment system and some patients felt the availability of non-urgent appointments needed to be reviewed.

The practice was not signed up to extended opening hours; however were actively reviewing access arrangements for working age people. Staff were involved in a pilot to provide GP access at the weekend within the local area.

A choose and book service was available for patients referred to hospitals or other secondary health services. This service enabled patients to book their own appointments and provided greater flexibility over when and where their medical examination took place.

The practice was proactive in offering health promotion and screening services that reflected the needs for this age group. This included NHS health checks being offered to patients aged 40 to 74 years and promoting of self-management of health conditions. Students were able to register as temporary patients during the school holidays.

People whose circumstances may make them vulnerable

Good

Updated 28 May 2015

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 people with a learning disability, epilepsy and in need of palliative care. The practice provided care to 70 registered patients with a learning disability, behavioural and mental health issues. Most of these patients resided in three local care provisions registered with the Care Quality Commission. Two senior staff members told us a good and responsive service was offered for their patients.

The practice had carried out annual health checks for people with a learning disability. They told us continuity of care was maintained by the GPs and their health books were completed. Health promotion services such as flu vaccinations, administration of insulin and weight clinics were offered by the practice.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people. This included the community learning disability team, community matron and the Macmillan nurse for patients receiving end of life care. Longer appointments and home visits were provided where needed.

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. Information was available to patients about how to access various support groups and voluntary organisations in a format they could understand.

People experiencing poor mental health (including people with dementia)

Good

Updated 28 May 2015

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

The practice worked with other multi-disciplinary teams to ensure the care needs of people experiencing poor mental health and dementia were regularly reviewed. This included working with care home staff in respect of advance care planning for people with dementia and referral to a local memory clinic for patients identified at risk of dementia. The majority of patients on the dementia register (88%) had received an annual review of the care needs.

The GPs worked closely with psychiatric consultants to ensure coordinated care for patients with both physical and mental health needs. This included facilitating risk assessments and care plans where appropriate, and regular review of their medicines. The practice had 37 patients on mental health register and 91% had received an annual physical health check.

The practice 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. Patients experiencing poor mental health had access to information on various support groups and voluntary organisations including counselling services / talking therapy.