You are here

Trentside Medical Group Good Also known as Netherfield Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 18 April 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Trentside Medical Group on 3 November 2015. Overall the practice is rated as good.

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

  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. Opportunities for learning were always considered and the practice adopted a candid and open approach.
  • Risks to patients were assessed and well managed. This included staff and patient health and safety.
  • Clinical audits had been carried out which demonstrated improved patient outcomes. One of the examples provided was a completed audit cycle.
  • The majority of patients told us they were treated with compassion, dignity and respect. A wide variety of information and support services were made available to the public.
  • The practice had offered extended hours appointments and had demonstrated flexibility in response to increasing patient demand. However, patient feedback indicated that further measures were required so patients could more easily access the service and appointments.
  • The practice had a number of policies and procedures to govern activity. Policies were reviewed, updated and accessible by staff.
  • The practice had sought feedback from patients and had an active patient participation group.

The areas where the provider should make improvement are:

  • Ensure that all staff have understanding of roles and responsibilities under the Mental Capacity Act 2005.

  • Ensure safeguarding training is undertaken by all clinical staff within the practice and all staff are aware of their duties and responsibilities in relation to identifying and reporting potential safeguarding concerns.

  • Ensure that the use of prescription pads is monitored within the practice.

  • Ensure that all staff undertaking chaperone duties receive formalised training to undertake their role.

  • Records of action plans should be held when regular audits in infection control are undertaken.

  • Ensure the management of staff training and record keeping in relation to the programme is strengthened.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 April 2016

The practice is rated as good for providing safe services.

  • Staff understood their responsibilities to raise concerns, and to report incidents and near misses. Lessons were shared to ensure action was taken to improve safety in the practice.

  • Risks to patients who used services were assessed and monitored. For example, up to date and accessible policies, medicines and vaccines handling and storage. The practice was equipped to deal with medical emergencies.

  • When there were unintended or unexpected safety incidents, patients received a verbal and written apology where appropriate.

Effective

Good

Updated 18 April 2016

The practice is rated as good for providing effective services.

  • Care was delivered in line with current and relevant based guidelines which included National Institute for Health and Care Excellence. (NICE)

  • The practice performance was performing in line with the national Quality Outcomes Framework (QOF) and was not identified as an outlier.

  • A community care homes team nurse closely monitored practice patients in residential care homes and updated practice clinicians. This had assisted in the reduction of unplanned admissions into hospital.

  • Staff worked with multi-disciplinary teams to coordinate the care of patients with multiple and / or complex health needs.

  • Most staff received training appropriate to their roles. There was however, a lack of a robust approach in relation to the management and recording of training.

  • Patients’ needs were assessed and care was planned and delivered in line with current legislation. However, not all staff could demonstrate that they had received training in relation to consent as outlined within the Mental Capacity Act 2005.

  • There was evidence that clinical audits undertaken had an impact in relation to patient outcomes. We were shown evidence of one fully completed audit cycle.

Caring

Good

Updated 18 April 2016

The practice is rated as good for providing caring services.

  • The majority of patients we spoke with and comment cards completed confirmed that people were treated with compassion, dignity and respect; and that they were involved in decisions about their care and treatment. We saw that staff treated patients with kindness and respect, and maintained their confidentiality.

  • Data showed that patients rated the practice similarly to local and national averages for several aspects of care. For example, patients had confidence and trust in the last GP they saw or spoke to and patients found the last GP they saw or spoke to was good at involving them in decisions about their care.

  • However, some areas were identified as being lower than the local and national averages. This included whether or not last nurse a patient saw or spoke to was good at treating them with care and concern, and the helpfulness of receptionists.

  • Information for patients about the services available was easy to understand and accessible. Information was targeted at people with a variety of different health concerns.

Responsive

Good

Updated 18 April 2016

The practice is rated as good for providing responsive services.

  • The practice had reviewed the needs of its population and had engaged with the Clinical Commissioning Group (CCG) and the NHS England Area Team to secure improvements to services where these were identified.

  • The practice had implemented measures to respond to the increasing demand for patient appointments. This included extended hours surgery to accommodate patients of working age. The practice had also offered telephone triage appointments to assess patients. This had reduced the need for some patients to attend the surgery and created more appointments for those required to be seen on the day.

  • The practice prioritised appointments for sick children and those urgently in need. It offered home appointments for those patients considered as vulnerable and unable to attend the practice.

  • Patients could get information about how to complain. Complaints were addressed and taken seriously by the practice and lessons learned. Apologies were offered to patients where appropriate.

Well-led

Good

Updated 18 April 2016

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

  • It had a vision and a strategy and staff were aware of this and their responsibilities in relation to it. There was a documented leadership structure and staff we spoke with felt supported by management.

  • The practice had a number of policies and procedures to govern activity. Policies were up to date and accessible by staff.

  • The practice engaged with an active patient participation group (PPG). This had resulted in arrangements being made for public engagement between clinicians and the local community at topical health awareness events. The PPG had sought patient feedback and fed results back to practice management.

  • Staff had received inductions, appraisals and were supported by management to undertake their roles. Management at the practice endorsed a no tolerance approach when reception staff had raised concerns about being treated aggressively by a minority of patients. This demonstrated management support for practice staff.

Checks on specific services

People with long term conditions

Good

Updated 18 April 2016

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

  • GPs and advanced nurse practitioners had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. For those people with the most complex needs, the named GP and nurse practitioners worked with the relevant health and care professionals to deliver a multidisciplinary package of care. Longer appointments and home visits were available when needed.

  • GPs provided clinical support where required to nursing staff who had roles in treating patients with long term conditions.

  • The practice had recall systems in place for those patients with a long term condition.

Families, children and young people

Good

Updated 18 April 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.

  • We saw detailed records of joint working with midwives and health visitors. Meetings were held regularly to discuss risks to vulnerable patients.

  • Immunisation rates were relatively high for all standard childhood immunisations and were in line with local averages.

  • Whilst appointments were considered to be difficult to access at times, priority was given to sick children. These included lunch time appointments with the practice medical team. Appointments were also available outside of school hours and the premises were suitable for children and babies.

  • The practice had attended a local comprehensive school in June 2015 to promote health awareness to students.

Older people

Good

Updated 18 April 2016

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

  • The practice had 757 patients aged over 75 on its register. The practice annually reviewed the records of patients not recently seen and checked if there were any health concerns which required patient contact. The practice had seen 734 elderly patients this year.

  • Nationally reported data showed that outcomes for patients with conditions commonly found in older people such as osteoporosis were good and were significantly above the local and national averages.

  • The practice had proactively engaged with the community care homes team nurse who regularly monitored the health needs of practice patients living in residential care homes.

  • A care homes pharmacist employed by the CCG had started working with the practice to ensure safe and cost effective care home prescribing.

  • The practice offered home visits and priority appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 18 April 2016

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

  • The age profile of patients at the practice in 2015 mainly comprised of working age persons 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 try and ensure these were accessible, flexible and offered continuity of care. Extended hours surgery was offered on weekdays which included appointments ranging from 7am to 7pm. Telephone triage appointments were also offered so that patients’ health problems could be discussed. This negated the need for some patients to attend the practice for face to face consultations.

People experiencing poor mental health (including people with dementia)

Good

Updated 18 April 2016

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

  • The practice had attended two community events with the Alzheimer’s Society which offered education to healthcare staff and carers of patients with dementia.

  • Alzheimer’s Society and Age UK had stalls on a monthly basis in the waiting room at the practice.

  • The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia.

  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations such as Focusline and the Samaritans.

  • The practice also encouraged those patients with mild to moderate mental health difficulties to self-refer to a therapy programme, Improving Access to Psychological Therapies (IAPT)

People whose circumstances may make them vulnerable

Good

Updated 18 April 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 those with a learning disability. There were 22 patients with severe learning disabilities and nine of these had received a health review, with the remainder planned for January to March 2016.

  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.

  • It had told vulnerable patients about how to access various support groups and voluntary organisations. The practice had referred a number of patients to a crisis intervention community support service run by the Red Cross. Information was also displayed within the practice waiting area.

  • Most staff knew how to recognise signs of abuse in vulnerable adults and children. GPs 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.