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Inspection Summary


Overall summary & rating

Good

Updated 20 March 2018

This practice is rated as Good overall. (Previous inspection August 2016 – Good)

The key questions are rated as:

Are services safe? – Good

Are services effective? – Good

Are services caring? – Good

Are services responsive? – Good

Are services well-led? - Good

As part of our inspection process, we also look at the quality of care for specific population groups. The population groups are rated as:

Older People – Good

People with long-term conditions – Good

Families, children and young people – Good

Working age people (including those recently retired and students – Good

People whose circumstances may make them vulnerable – Good

People experiencing poor mental health (including people with dementia) - Good

We carried out an announced comprehensive inspection at Talbot Medical Centre on 9 February 2018 as part of our inspection programme.

At this inspection we found:

  • Talbot Medical Centre had merged with another practice in January 2017. The practice had increased the patient list size, taken on an additional branch practice known as Northbourne Surgery and employed additional staff.

  • The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.

  • The practice routinely reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence- based guidelines.

  • Staff involved and treated patients with compassion, kindness, dignity and respect.

  • The practice met with Bournemouth University’s student union four times a year to capture feedback and discuss improvement of provision of services for patients who attended university.

  • Patients found the appointment system easy to use and reported that they were able to access care when they needed it.

  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

  • The practice used the Electronic Frailty Index (EFI) for patients over 65 years to help identify and predict risks for older patients in primary care. Patients identified as living with severe frailty were also reviewed every month at multi-disciplinary meetings in order to co-ordinate care to meet individual needs.

  • The practice used a text message system to remind patients of appointments.
  • The practice helped to establish the Dorset Acute Integrated Respiratory Service (DAIRS) which provides support and services for patients with chronic respiratory diseases across Dorset. These services included the ability for patients to self-refer to hospital, receive intravenous antibiotics at home, access specialist clinics, and access educational and exercise groups.

  • The practice has a ‘dementia friendly’ status which they achieved by ensuring all staff had undertaken dementia training and modifications had been made to the signage and toilets at the location to help patients with dementia find their way around the building more easily.

  • The practice offered an ‘open access’ emergencies surgery’ between 9am until 11.30am and 3pm until 5.30pm Monday to Friday, for patients to attend without a pre-booked appointment.

The areas where the provider should make improvements are:

  • Continue to review the processes for patients with long term conditions to improve uptake of reviews by patients for better health outcomes.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 20 March 2018

Effective

Good

Updated 20 March 2018

Caring

Good

Updated 20 March 2018

Responsive

Good

Updated 20 March 2018

Well-led

Good

Updated 20 March 2018

Checks on specific services

People with long term conditions

Outstanding

Updated 31 August 2016

The practice is rated as outstanding for the care of people with long-term conditions.

  • The practice held long term condition registers for all those patients so that they were closely monitored. All patients had a lead clinician for each area of these conditions. These patients were invited regularly to attend for structured disease specific reviews with GP or practice nurses.
  • 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.
  • The practice was part of the North Bournemouth Poly-pharmacy review project which looked at patients who take more than 10 medicines. This had seen more than 100 patients having their medicines reviewed to ensure they were provided with the most effective treatment for their diagnosed conditions.
  • There were local community specialist services for patients with specific breathing and lung diseases. Patients with a diagnosis of breathing conditions, including chronic obstructive pulmonary disease (COPD), asthma, pulmonary fibrosis or bronchiectasis could access a community respiratory service called DAIRS (Dorset Acute Integrated Respiratory Service). This service had been set up by a GP within the practice and aimed to provide patients with alternatives to going to hospital when they became unwell. The GPs and consultant colleagues provided access to educational, exercise groups and self-management advice as well as urgent access to services and medicines for patients and clinicians managing these patients. The practice had monthly clinics with a respiratory nurse specialist to review patients with COPD.
  • The practice held monthly clinics with a diabetes nurse specialist from Royal Bournemouth Hospital to review selected patients with diabetes.
  • Staff at the practice held an in house smoke stop service providing help and support to patients and those of neighbouring practices. Patients over 45 years of age who smoked and had been prescribed medicines for respiratory problem in the previous 12 months were invited to attend for a breathing assessment and consultation with nurse. The practice had identified a number of patients with previously undiagnosed COPD and were able to address this and their smoking.
  • During the last 2 years’ influenza vaccination programmes the practice had checked pulse rates of all over 65 year olds. Those with an irregular pulse were then invited for heart monitoring. This had identified a number of patients with previously unrecognised atrial fibrillation which was then appropriately managed.

Families, children and young people

Good

Updated 31 August 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 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.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. The practice shared their computer system with the health visiting/community teams which demonstrated the practice were working towards integrated patient record systems, providing greater opportunity of monitoring and identification of risks.
  • Practice staff met every six to eight weeks with the health visiting team to discuss identified families and children who were on the child protection, child in need, and looked after children registers. This provided an opportunity to discuss families where there were new concerns.
  • The practice provided a full range of contraceptive services including long acting reversible contraception (LARC) and emergency contraception, cervical screening and chlamydia testing.

  • The practice had a designated midwife. GPs could refer diabetic and patients with epilepsy for pre-pregnancy counselling with the midwife.

Older people

Good

Updated 31 August 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.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • A group of GPs in the locality employ an MDT coordinator. Monthly multidisciplinary team meetings were held to discuss patients identified at particular risk. GPs used a frailty index to highlight vulnerable older patients who were then placed on a ‘Virtual Ward’ to raise awareness and increase monitoring.
  • The GPs had signed up to run an ‘Avoiding unplanned admission’ programme and had managed to reduce the emergency admissions in the over 85’s from 298 in 2014-2015 to 273 in 2015-2016.

Working age people (including those recently retired and students)

Good

Updated 31 August 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.
  • There was a range of options to access services at the practice. Booked appointments, telephone contact and walk in appointments were available for urgent problems. These could be accessed via telephone, online booking or walking in and discussion with the receptionist. Extended opening was available on Tuesday and Thursday evenings from 6.30pm until 8.15pm.
  • Text appointment reminders were used for patients who had signed up for this.
  • The practice used an electronic prescribing allowing patients to order medicines online and then collect from the pharmacy of their choice.
  • The practice referred patients to the local public health schemes to promote lifestyle changes including access to local leisure centres, weight loss programmes, other stop smoking services as well as a full range of local voluntary and charitable organisations.

People experiencing poor mental health (including people with dementia)

Good

Updated 31 August 2016

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

  • 83.56% of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the national average.
  • 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.
  • Patients who did not attend the practice for their appointments were actively followed up to check on their well being.
  • The practice had recently carried out an education session for all staff about dementia which was well received. As a result the practice had become a “dementia friendly” practice. Modifications had been made to the signage and toilets in the practice to help patients with dementia. The staff had access to memory cafes and a specialist memory team for diagnostic help and on-going support.

People whose circumstances may make them vulnerable

Good

Updated 31 August 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, travellers and those 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 and how to contact relevant agencies in normal working hours and out of hours.
  • The practice had a safety net system to review and check the well being of vulnerable patients who had not requested medicines for 40 days.
  • There was a system to identify the carers and offer them support. The practice ran an in-house carer support group. This provided information for carers and had allowed the development of a local support network.