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Drs Meachim, Bushell, Nicholson & Shergill Good Also known as Garden Lane Medical Centre

Inspection Summary


Overall summary & rating

Good

Updated 25 August 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Drs Meachim, Bushell, Nicholson & Shergill on 14 June 2016. The overall rating for the practice was good. However, the practice was rated as requires improvement for providing safe services. The full comprehensive report for the 14 June 2016 inspection can be found by selecting the ‘all reports’ link for Drs Meachim, Bushell, Nicholson & Shergill on our website at www.cqc.org.uk.

This inspection was an announced focused review carried out on 25 July 2017 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breach in regulation that we identified at our previous inspection on 14 June 2016. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is rated as good.

Our key findings were as follows:

  • The provider had taken action to improve staff recruitment records to confirm the suitability of staff employed.

The following improvements to the service had also been made:

  • A system had been introduced to document reviews of significant events to demonstrate that actions identified had been implemented.

  • Further information on the role and remit of the nurse clinician had been made available so patients could make an informed choice when making appointments.

  • The system for identifying staff training requirements had been reviewed.

  • Staff had received training updates in adult and child safeguarding.

  • The system for the investigation of complaints had been reviewed to ensure that all complaints were fully addressed and the records demonstrated how the complaint was investigated, learning outcomes and action taken.

The areas where the provider should make improvements are:

  • Where there is ongoing action being taken to address a complaint this should be fully documented to demonstrate that this is taking place.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 25 August 2017

The practice is rated as good for providing safe services. The provider had taken action to improve staff recruitment records to confirm the suitability of staff employed.

Effective

Good

Updated 5 August 2016

The practice is rated good for providing effective services. Patients’ needs were assessed and care was planned and delivered in line with current legislation. Staff referred to guidance from the National Institute for Health and Care Excellence (NICE) and used it routinely. Staff worked with other health care teams and there were systems in place to ensure appropriate information was shared. Audits of clinical practice were undertaken. A system for ensuring the regular appraisal of staff was in place. The records of all staff training needed to be improved to assist in monitoring and planning for the training needs of staff.

A record was also not made of patients subject to deprivation of liberty safeguards (DoLS).

Caring

Good

Updated 5 August 2016

The practice is rated as good for providing caring services. We saw staff treated patients with kindness and respect. Patients spoken with and who returned comment cards were positive about the care they received from the practice. They commented that they were treated with respect and dignity and that staff were caring, supportive and helpful. Patients felt involved in planning and making decisions about their care and treatment.

Responsive

Good

Updated 5 August 2016

The practice is rated good for providing responsive services. Services were planned and delivered to take into account the needs of different patient groups. The National Patient Survey indicated that patient satisfaction with access to the service was comparable to local and national averages. However, in relation to seeing a GP of the patient’s choice the results were lower than local and national averages. The practice was aware of this patient feedback and had taken action to address the issues identified and were monitoring patient access to ensure it met their needs. There was a system for the investigation of complaints however improvements should be made to this to ensure that all complaints are fully addressed. The investigation process should clearly show all actions taken to reach an outcome, what has been learned and any action taken as a result.

Well-led

Good

Updated 5 August 2016

The practice is rated good for providing well-led services. There were systems in place to monitor the operation of the service. Staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. The practice sought feedback from staff and patients, which it acted on. The practice had a focus on continuous learning and improvement.

Checks on specific services

People with long term conditions

Good

Updated 5 August 2016

The practice is rated as good for the care of people with long-term conditions. The practice held information about the prevalence of specific long term conditions within its patient population such as diabetes, chronic obstructive pulmonary disease (COPD), cardio vascular disease and hypertension. This information was reflected in the services provided, for example, reviews of conditions and treatment, screening programmes and vaccination programmes. The practice had a system in place to make sure no patient missed their regular reviews for long term conditions. The clinical staff took the lead for different long term conditions and kept up to date in their specialist areas. The practice had multi-disciplinary meetings to discuss the needs of palliative care patients and patients with complex needs. The practice worked with other agencies and health providers to provide support and access specialist help when needed. The practice provided support and information to patients to encourage them to manage their long term conditions and provided care plans to patients to assist with this.

Families, children and young people

Good

Updated 5 August 2016

The practice is rated as good for the care of families, children and young people. Child health surveillance and immunisation clinics were provided. Appointments for young children were prioritised. The staff we spoke with had appropriate knowledge about child protection and how to report any concerns. Some staff did not have safeguarding children training relevant to their role. A plan was put in place to address this following our visit. The safeguarding lead staff liaised with the health visiting service, school nurses and midwife to discuss any concerns about children and how they could be best supported. Family planning and sexual health services were provided.

Older people

Good

Updated 5 August 2016

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

The practice was knowledgeable about the number and health needs of older patients using the service. They kept up to date registers of patients’ health conditions and used this information to plan reviews of health care and to offer services such as vaccinations for flu and shingles.

The

practice worked with other agencies and health providers to provide support and access specialist help when needed.

The practice worked with the Clinical Commissioning Group (CCG) and with a cluster of four other practices to enhance patient care. For example, the practices had developed a role for and employed a nurse practitioner to work with elderly patients. The aim of this role being to take practice nursing services, such as chronic disease management out to housebound patients and to prevent hospital admissions where possible. Clinicians visited a local nursing home once a week to review patient health and respond to any concerns identified. Care plans were developed for older people with the aim of ensuring all necessary support was provided and reducing hospital admissions. Annual health checks for patients over 75 years of age were carried out.

Working age people (including those recently retired and students)

Good

Updated 5 August 2016

The practice is rated as good for the care of working-age people (including those recently retired and students). The practice offered pre-bookable appointments, book on the day appointments and telephone consultations. The practice was also piloting E-consult which provided self-care advice for patients and an email facility for queries as an alternative method of accessing the service. Patients could book appointments on-line or via the telephone and repeat prescriptions could be ordered on-line which provided flexibility to working patients and those in full time education. The practice was open from 8:00am to 6:00pm Monday to Friday allowing early morning and late evening appointments to be offered to this group of patients.

An extended hour’s service for routine appointments was commissioned by West Cheshire CCG. The practice website provided information around self-care and local services available for patients. Reception staff were able to sign post patients to local resources such as Pharmacy First (local pharmacies providing advice and possibly reducing the need to see a GP) and the Physio First service (this provided physiotherapy appointments for patients without the need to see a GP for a referral). The practice had undertaken a recent survey of students attending the University of Chester to inform the provision of services. The practice was working with the University to look at publicising health services for students. The practice website offered advice to students on how to register with the practice and services offered. One of the practice nurses worked predominantly with the student population. A nurse-led student health service was offered each week day and a telephone line was available specifically for students. Telephone calls were triaged and either a nurse or GP appointment provided.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 August 2016

The practice is rated good for the care of people experiencing poor mental health (including people with dementia). The practice maintained a register of patients receiving support with their mental health. Patients experiencing poor mental health were offered an annual review. Patients who did not keep appointments were followed up to ensure the practice was monitoring their health needs appropriately. The practice regularly worked with multi-disciplinary teams in the case management of people experiencing poor mental health, including those with dementia. The practice carried out assessments of patients at risk of dementia to encourage early diagnosis and access to support.  

People whose circumstances may make them vulnerable

Good

Updated 5 August 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable. Patients’ electronic records contained alerts for staff regarding patients requiring additional assistance. For example,

if a patient had a learning disability to enable appropriate support to be provided. There was a recall system to ensure patients with a learning disability received an annual health check. Staff we spoke with had appropriate knowledge about safeguarding vulnerable adults and they had access to an appropriate policy and procedure.

Some staff had not received up to date training in adult safeguarding.

Se

rvices for carers were publicised and a record was kept of carers to ensure they had access to appropriate services. The practice referred patients who were over 18 and with long term health conditions to a well-being co-ordinator for support with social issues that were having a detrimental impact upon their lives. The practice referred patients to local health and social care services for support, such as drug and alcohol services.