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Canterbury Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 19 January 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Canterbury Health Centre on 20 October 2016. 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 report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • The practice had strong and visible clinical and managerial leadership and governance arrangements.
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • The provider was aware of and complied with the requirements of the duty of candour.

We saw areas of outstanding practice:

  • There was an exemplary approach to reporting and learning from significant events and the volume of reported events was very high. Learning from the practice was discussed amongst local GPs during training events.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 19 January 2017

The practice is rated as good for providing safe services.

  • Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses. There was an exemplary approach to reporting and learning from significant events and the volume of reported events was very high.
  • Medical alerts were acted on quickly and effectively.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • The practice used every opportunity to learn from incidents, to support improvement. Learning was based on a thorough analysis and investigation.
  • Information about safety was highly valued and was used to promote learning and improvement.
  • Risk management was comprehensive, well embedded and recognised as the responsibility of all staff.

Effective

Good

Updated 19 January 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the national average. The practice performance was had been consistenly higher than the local and national averages over the last three years.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Clinical audits demonstrated quality improvement. There were non clinical audits that supported effective treatment.
  • The practice participated in a community hub operating centre (CHOC) pilot aimed at improving communication between health and social care services
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was evidence of appraisals and personal development plans for all staff.
  • Staff worked with other health care professionals to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 19 January 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for almost all aspects of care.
  • Patients said they were treated with compassion, dignity and respect and they were involved in decisions about their care and treatment.
  • Information for patients about the services available was easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • When dealing with safeguarding incidents the practice routinely gave specific attention to the impact the issues might have had on any carers involved.

Responsive

Good

Updated 19 January 2017

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and engaged with the NHS England Area Team and Clinical Commissioning Group to secure improvements to services where these were identified.
  • Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • Information about how to complain was available and easy to understand and evidence showed the practice responded quickly to issues raised. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 19 January 2017

The practice is rated as good for being well-led.

  • The practice had a clear vision and strategy to deliver high quality care and promote good outcomes for patients. Staff were clear about the vision and their responsibilities in relation to it.
  • High standards were promoted and owned by all practice staff and teams worked together across all roles.
  • There was a high level of constructive engagement with staff and a high level of staff satisfaction.
  • There was a clear leadership structure and staff felt supported by management. The practice had a number of policies and procedures to govern activity and held regular governance meetings. There was clear succession planning.
  • There was an overarching governance framework which supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.
  • The provider was aware of and complied with the requirements of the duty of candour. The partners encouraged a culture of openness and honesty. The practice had systems for managing notifiable safety incidents and ensured this information was shared with staff to help ensure appropriate action was taken
  • The practice proactively sought feedback from staff and patients, which it acted on.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 19 January 2017

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

  • Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority.
  • Performance for diabetes related indicators was better than the clinical commissioning group (CCG) and/ national average. For example the percentage of patients on the diabetes register, with a record of a foot examination and a risk classification within the proceeding twelve months had been consistently higher than local and national averages since 2005 and currently was 92% compared to a national average of 89%. The practice had outperformed the national average by between 1% and 11% every year over the last ten years
  • Longer appointments and home visits were available when needed. This included, learning disability, mental health and patients with dementia as well as those who needed translation services or homeless patients.
  • 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.

Families, children and young people

Good

Updated 19 January 2017

The practice is rated as good for the care of families, children and young people.

  • There were systems 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 accident and emergency (A&E) attendances. Immunisation rates were relatively high for all standard childhood immunisations.
  • We saw that children and young people were treated in an age-appropriate way and were recognised as individuals.
  • The practice’s uptake for the cervical screening programme was 81%, which was comparable to the CCG and national average of 83%.
  • The practice offers a full contraceptive service including long-acting reversible contraceptives such as the fitting of an intrauterine device. (A device inserted into the womb to prevent pregnancy). This service was offered to their own and other practices’ patients.
  • 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.

Older people

Good

Updated 19 January 2017

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.
  • There was an anti coagulation service (anti coagulation is the use of thinning agents/medicines to prevent blot clots, which requires regular monitoring through blood tests) that visited patients in their own homes if needed.
  • The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 19 January 2017

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.

People experiencing poor mental health (including people with dementia)

Good

Updated 19 January 2017

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

  • Eighty two per cent of patients diagnosed with dementia who had their care reviewed in a face to face meeting in the last 12 months for which figures were available (to March 2015), which is comparable to the national average.

  • Ninety per cent of patients diagnosed with a mental health disease had a care plan during the last 12 months. This was better than the CCG at 83% and the national average at 88%. The practice had outperformed the national average and local average every year for the last four years.

  • 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 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.

People whose circumstances may make them vulnerable

Good

Updated 19 January 2017

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. Homeless patients were able to register with the practice using the practice’s address or the address of a local homelessness support organisation.
  • 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.
  • When dealing with safeguarding incidents the practice routinely gave specific attention to the impact the issues might have had on any carers involved.