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Archived: Cassidy Medical Centre Requires improvement

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Inspection Summary


Overall summary & rating

Requires improvement

Updated 22 January 2015

Letter from the Chief Inspector of General Practice

The practice is rated as requires improvement

Our key findings were as follows:

  • Patients were satisfied with access to the practice. There was a flexible appointment system, a weekend walk-in service and online consultations offered.
  • Patients said the practice was caring and staff treated them with dignity and respect. They said clinical staff involved them in decisions about their care and treatment.
  • On the day of our inspection the practice was clean, hygienic and well equipped.
  • The practice had some governance arrangements in place and was supported by the providers corporate team.
  • The practice actively sought patient’s feedback and acted on it.

We found areas of outstanding practice including:

  • The practice offered online consultations for a range of medical conditions allowing patients to receive advice or treatment from their home.
  • The practice had a close working relationship with a local charity that offered community support to patients with non-medical needs. The practice attended regular meetings with the charity to identify patients who might benefit from this form of support. The charity offered a telephone counselling service for these patients.
  • A weekend walk-in service was available accessible to patients who were unregistered.

         

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

Importantly, the provider must:

  • Share learning from significant events/complaints with all staff
  • Disseminate safety alerts to appropriate staff and ensure they are acted on
  • Hold regular clinical meetings to share best practice and learning from significant events/complaints
  • Carry out clinical audit to improve outcomes for patients
  • Ensure all patients with long-term conditions are reviewed appropriately
  • Develop care plans for all patients with complex needs
  • Ensure all patients medical records are accurate and up to date

In addition the provider should:

  • Ensure all staff are aware of the practice mission statement/aims and objectives
  • Proactively offer health checks for patients over 40 years old and influenza vaccinations for ‘at risk’ patients

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for safe.

Safeguarding procedures were in place to protect children and adults from harm. Medicines were managed safely and staff were trained to respond to medical emergencies. The practice was clean and hygienic and infection control procedures were followed by staff.

Significant events were reported and analysed however learning was not shared with all staff and safety alerts received from the NHS were not disseminated and acted on.

The practice had health and safety risk assessments in place and where risks had been identified control measures were in place to minimise them.

The required pre-employment checks had been completed on all staff.

Effective

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for effective.

Clinical staff had access to best practice standards and guidance however not all patients had their needs assessed and care planned in accordance with these. We found that the care for some patients fell short of effective practice putting them at risk of avoidable health problems. We viewed a sample of patient’s case notes. Two out of five patient’s had not had their long-term conditions reviewed and three out of five patients with complex needs did not have a care plan in place.

The practice was not carrying out regular clinical audits and using them in a systematic way to improve outcomes for patients.

The practice worked with other service providers to meet patients' needs. These included the palliative care team, mental health team, community health visitor, district nurse and tissue viability services.

We found no clinical meetings were held to share best practice standards and guidance.

We found where a Do Not Attempt Resuscitation (DNAR) had been agreed for a patient in a palliative care meeting there was no evidence of this decision in the patients case notes.

Health checks for patients over 40 years old and influenza vaccinations for ‘at risk’ patients were not proactively offered.

Caring

Good

Updated 22 January 2015

The practice is rated as good for caring.

We spoke to 14 patients, received 27 completed Care Quality Commission (CQC) comment cards, and reviewed the results of the national patient survey 2014. Feedback showed that patients were satisfied with the services provided in terms of the practice being caring. Patients said staff treated them with dignity and respect and their privacy was respected.

Patients said clinical staff involved them in decisions about their care and treatment and consent was sought before physical examinations were carried out. GPs were able to demonstrate an understanding of Gillick competences when obtaining consent from children.

Patients were positive about emotional support provided by staff and the practice had a close working relationship with a local charity that offered community support to patients with social needs.

Responsive

Good

Updated 22 January 2015

The practice is rated as good for responsive.

The practice had recognised the needs of different groups in the planning of its services. This included a flexible appointment system and a weekend walk-in service which was accessible to patients who were unregistered. Online consultations were also offered through the practice website. Longer appointments and a named GP were available for older patients over 75 years and home visits for those who were housebound.

The practice was accessible to patients with mobility needs and an interpreter service was available to patients whose first language was not English to help them with their communication needs.

We found that 12 out of 14 patients we spoke to expressed concern about the lack of continuity of care at the practice. Patients were dissatisfied with the constant turnover of clinical staff and this caused them distress. This was also reflected in the completed Care Quality Commission (CQC) comment cards we received, feedback on the NHS Choices website and the national patient survey 2014 where the practice scored below both the CCG and national averages for patients with a preferred GP who usually got to see or speak to that GP.

The practice had a system in place for handling complaints and they had been responded to in a timely manner in line with the practices complaints procedure.

Well-led

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for well-led.

The practice had leadership and governance arrangements in place. Staff were clear on their level of responsibility and who to report to with any issues. The practice had a statement of purpose with clear aims and objectives however, staff we spoke to were not able to articulate these.

Staff said they were supported and listened to by managers however, we found no formal clinical meetings had been held in the previous nine months and two clinical staff were unaware of the clinical governance newsletter. Mechanisms for sharing clinical learning within the practice were weak.

Some systems were in place to monitor the quality of services provided however the practice was not carrying out regular clinical audits and using them in a systematic way to improve outcomes for patients.

The practice had a Patient Participation Group (PPG) to represent patients and regular internal surveys had been carried out to gain patients views of the practice. The practice monitored comments from patients on the NHS Choices website and responded to negative feedback.

Checks on specific services

People with long term conditions

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for the population group of people with long-term conditions.

The practice provided clinics for patients with a variety of long-term conditions including asthma, diabetes and chronic obstructive pulmonary disorder (COPD).  We found that some patients with long-term conditions had not had their conditions reviewed putting them at risk of avoidable complications or deterioration. We reviewed five case notes of patients with long-term conditions and found two patients had not had a review in the previous 12 months. We found that a patient with diabetes had not been regularly reviewed for their condition despite attending a recent consultation for another condition commonly associated with diabetes.

The provider was rated as requires improvement for safe, effective and well-led this includes for this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Families, children and young people

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for the population group of families, children and young people.

Services were available for this population group. The practice did not provide family planning clinics however pre and post natal support was provided by the GPs and nurse team. A wide variety of information was available on the practice website targeted at families, children and young people.

The practice referred patient’s to a specialist service for HIV testing and treatment for sexually transmitted diseases.

Child immunisation/vaccination services were available in line with national guidelines. Data showed that the practice had scored below the CCG average for most immunisations in the previous year.

The provider was rated as requires improvement for safe, effective and well-led this includes for this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Older people

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for the population group of older people.

The practice was responsive to the needs of older people including longer appointments, personalised care plans and a named GP for those patients over 75 years. Home visits were available for older patients and a dedicated phone line was in place so homebound patients could contact the practice when necessary.

The practice had safeguarding procedures in place for older people. Staff  had been trained in safeguarding vulnerable adults and were aware of the reporting procedures if they had any concerns.

Regular meetings were held to plan care and treatment for patients requiring end of life care. However we found that important decisions relating to them had not always been recorded in their case notes.

The provider was rated as requires improvement for safe, effective and well-led this includes for this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

Working age people (including those recently retired and students)

Requires improvement

Updated 22 January 2015

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

The practice had a flexible appointment system including extended surgery hours on Wednesdays from 6.30pm to 7.30pm and a weekend walk-in service for patients requiring an appointment outside of normal working hours. The practice offered online registration and appointments and online consultations for a variety of conditions.

The practice had information on their website on a wide range of health conditions including information specific to men’s and women’s health. Smoking cessation clinics were not provided and patients were referred to a local smoking cessation service to help them quit smoking. The practice had not monitored how many of their patients referred to this service had successfully managed to stop smoking.

The provider was rated as requires improvement for safe, effective and well-led this includes for this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

People experiencing poor mental health (including people with dementia)

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for the population group of people experiencing poor mental health (including people with dementia).

The practice offered annual physical health checks for patients experiencing poor mental health however the practice was unable to provide data on how many patients had received one. Non-attendances were followed up by staff. Staff had attended a training day covering mental health issues and reception staff knew to be flexible with patient’s adherence to appointment times when appropriate.

The practice had scored above the national average for the percentage of patients diagnosed with dementia whose care has been reviewed in the previous 15 months and the percentage of patients with physical and/or mental health conditions whose notes contain an offer of support and treatment within the preceding 15 months.

The practice had sign-posted patients experiencing poor mental health to support groups such as the local Mind team.

The practice had information on their website targeted at patients experiencing poor mental health. This included information on anxiety, depression, low mood and panic attacks. Information was also available on depression.

The provider was rated as requires improvement for safe, effective and well-led this includes for this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.

People whose circumstances may make them vulnerable

Requires improvement

Updated 22 January 2015

The practice is rated as requires improvement for the population group of people whose circumstances may make them vulnerable.

The practice supported patients living in vulnerable circumstances. There was a weekend walk-in service accessible to unregistered patients and those who were homeless.

The practice had a register of patients with learning disabilities and these patients were offered annual health checks. The practice had developed a template written in simple English with pictures to explain the importance of health checks and inviting patients in for an appointment with the GP to encourage them to access the service.

The practice had a close working relationship with a local charity that offered community support to patients with non-medical needs. The practice attended regular meetings with the charity to identify patients who might benefit from this form of support. The charity offered a telephone counselling service for these patients. The practice also supported the food bank scheme and was a designated supplier of food vouchers.

Home visits were available for patients who were housebound.

The provider was rated as requires improvement for safe, effective and well-led this includes for this population group. The concerns which led to these ratings apply to everyone using the practice, including this population group.