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The Groves Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 7 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of The Groves Medical Centre on 12 May 2015. Breaches of legal requirements were found. After the comprehensive inspection, the practice wrote to us to say what they would do to meet the legal requirements in relation to the breaches of regulation 12(1)(a)(d)(e) Safe care and treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We undertook this desk-based focussed inspection on 14 June 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. This report covers our findings in relation to those requirements and where further improvements have been made since the comprehensive inspection. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Groves Medical Centre on our website at www.cqc.org.uk.

The practice was previously rated as Good overall following the comprehensive inspection, however the practice was rated as Requires improvement for people whose circumstances make them vulnerable. Specifically, following this focussed inspection we now found the practice to be good for providing safe services.

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

  • Risks to patients were assessed and well-managed, specifically those related to health and safety, equipment checks and responding to emergencies.
  • Systems were in place to ensure that safety alerts and significant events were actioned appropriately.

Professor Steve Field CBE FRCP FFPH FRCGP

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 7 September 2016

The practice is rated as good for providing safe services as improvements had been made.

Risks to patients were assessed and well-managed, specifically those related to health and safety, equipment checks and responding to emergencies.

Effective

Good

Updated 7 September 2016

Caring

Good

Updated 7 September 2016

Responsive

Good

Updated 7 September 2016

Well-led

Good

Updated 7 September 2016

Checks on specific services

People with long term conditions

Good

Updated 9 July 2015

The provider was rated as good for the care of people with long term conditions.

The percentage of patients at the practice with a long standing health condition or with health related problems in daily life were 46.3% and 35.2%. These were lower than the England averages of 54% and 48.8%. There was a lead GP for each LTC. Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. For example there was a diabetic service lead GP and nurse. The practice offered insulin initiation and access to an on-site dietician. There were 665 patients on the diabetes register of whom 154 were insulin dependent.

The practice had increased its nursing complement and had respiratory specialists to provide a service to patients with chronic obstructive pulmonary disease (COPD). The practice had 188 patients on its COPD register, and 865 patients with asthma. We were told these patients were invited to attend for a review between September and November to try to minimise respiratory problems that became more prevalent in the winter months. Where appropriate these patients were supplied with emergency medicines.

Longer appointments and home visits were available when needed. All these patients had a named GP and were invited 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 named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care. All cancer patients received a review from their named GP shortly after diagnosis and we were told the senior partner telephoned every patient with a new diagnosis.

Families, children and young people

Good

Updated 9 July 2015

The provider was rated as good for the care of families, children and young people.

The practice had more children aged 0 to 4 (6.5%) and 5 to 14 (14%) than the England averages of 6% and 11.4%. The income deprivation level affecting children was 11 compared to the national level of 22.5. Both pre and ante natal care was provided by the doctors and visiting midwives. A health visitor was attached to the practice and was available for advice and clinics.

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.

The practice offered contraceptive advice and a sexual health service and where appropriate patients could have coils or implants inserted. Chlamydia and HIV testing and advice was available.

There was a designated GP who led on child protection.

Older people

Good

Updated 9 July 2015

The provider was rated as good for the care of older people.

The practice had a lower percentage of patients over the ages of 65 (13.5%) and 75 (6.4%) than the national average – 16.7% and 7.6% respectively. The income deprivation level affecting older people was 13 compared to the England figure of 22.5.

Nationally reported data showed that most outcomes for patients were in line with the national average for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population, for example all patients over the age of 75 had a named GP. The practice had signed up to the Avoiding Unplanned Admission enhanced service. In the records we reviewed we saw the patients who were part of this enhanced service had a care plan however these could be further developed. The practice was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

The practice was the sole provider of GP care at five local nursing and residential homes, and feedback from them was positive with regard to the caring and responsive nature of the doctors. All homes appreciated having a named GP for their regular clinics.

The practice told us they had close working relationships with District Nursing, the Community matron, the Impact team and the Rapid Response Team. They signposted patients who required further advice and care to social care services, voluntary groups; and made onward referrals to other professionals such as pulmonary rehabilitation services, speech and language services and dietetics.

Working age people (including those recently retired and students)

Good

Updated 9 July 2015

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

The number of working age patients at the practice was comparable to the England average. The percentage of patients with a caring responsibility was lower than the national average at 13% compared to 18.2%. 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 offered some online services including repeat prescriptions. Telephone consultations were available, and we were told patients could register to view their test results online, although we could not find details of this service on the practice website.

Extended hours, including phlebotomy, were available for appointments early on Tuesdays and Thursdays at 7.00 am, and until 8.00pm on Wednesdays. Patients could book an NHS health check online, and the practice offered temporary registration for students. Students were offered meningococcal meningitis boosters prior to university and Measles, Mumps and Rubella vaccination if required.

Patients could contact the practice via email if they found this easier.

People experiencing poor mental health (including people with dementia)

Good

Updated 9 July 2015

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

Data from QOF indicated the practice exceeded the national average for having a comprehensive care plan in place for patients with schizophrenia, bipolar affective disorder and other psychoses achieving 96% compared to the national average of 86%.

The practice liaised closely with the community mental health team (CMHT) and offered onsite counselling including Cognitive Behavioural Therapy. Support was offered to families and carers of patients with poor mental health and they were signposted to other organisations and groups who could offer further help.

Annual physical and checks and MH reviews were offered and 80% of these patients had had a review in the past year. The onsite pharmacy could supply medicines on a weekly basis and in blister packs where this was appropriate to aid compliance and avoid harm. The computer system would flag up to receptionists if a patient with a mental health illness wanted an appointment, and patients who required a double appointment were offered one.

The practice had improved its dementia diagnosis rate from just below 19% (national average 54%) to over 50% by providing an increased level of cognitive screening.

People whose circumstances may make them vulnerable

Requires improvement

Updated 9 July 2015

The provider was rated as requires improvement 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, patients with an addiction and those with a learning disability. It offered annual health checks for people with a learning disability however only seven out of 21 of these patients had received such a check-up. It offered longer appointments for people with a learning disability. The practice prescribed for methadone users and also provided services for alcohol dependent patients.

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.