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Review carried out on 17 September 2019

During an annual regulatory review

We reviewed the information available to us about Arden Medical Centre on 17 September 2019. We did not find evidence of significant changes to the quality of service being provided since the last inspection. As a result, we decided not to inspect the surgery at this time. We will continue to monitor this information about this service throughout the year and may inspect the surgery when we see evidence of potential changes.

Inspection carried out on 26/03/2019

During a routine inspection

We carried out an announced comprehensive inspection at Arden Medical Centre on 26 March 2019 as part of our inspection programme.

At the previous inspection in January 2016 we rated the practice as Outstanding overall and specifically in Caring, Responsive and Well Led.

Features then included:

  • Opportunistic screening for dementia during flu clinics.
  • Working with a local psychiatrist to implement a memory screening tool.
  • An in-house dermatology clinic offering cryotherapy twice a month.
  • Higher than average patient feedback from the GP National Patient survey.
  • A project offering Skype consultations.
  • A strong theme of positive feedback from staff and other organisations.

We based our judgement of the quality of care at this service at this inspection on a combination of:

  • what we found when we inspected
  • information from our ongoing monitoring of data about services and
  • information from the provider, patients, the public and other organisations.

We have rated this practice as good overall and outstanding for responsive and for the population groups of children, families and young people and people experiencing poor mental health (including people with dementia).

We rated the practice as outstanding for responsive service and the population groups of children, families and young people and people experiencing poor mental health (including people with dementia) because:

  • GPs had attended a local school to highlight the role of a GP and to encourage young people to communicate their health issues to parents or guardians and teachers.
  • There were good working relationships with local community providers specifically for patients in this group for example SOLAR, a local mental health and wellbeing support service for children and young people.
  • The practice had sought advice from local consultants on how to assess for dementia in patients with a learning disability and subsequently used the Dementia Screening Questionnaire for Individuals with Intellectual Disabilities Questionnaire (DSQIIID) form to screen patients on an annual basis.
  • The practice had identified individual patient’s needs and had allocated different areas for patients to wait for their appointment if required; this included a quiet corner in the waiting area. We were told that in addition to this if a patient was very anxious in a social environment they had an agreement in place that patients could wait outside the main area to be called for their appointment.
  • The practice actively used the Abbey Pain Scale method of assessment for pain for patients. This tool allows clinicians to assess pain in patients who have dementia or communication difficulties. It covered areas such as changes in facial expression, body language and behavioural changes. All assessments were documented on a template and stored in the patient’s notes.

We also rated the practice as good for providing, safe, effective, caring, responsive and well-led services because:

  • The practice provided care in a way that kept patients safe and protected them from avoidable harm.
  • There was an open and transparent approach to safety and a system in place for recording, reporting and learning from significant events. The practice had clear systems to manage risk so that safety incidents were less likely to happen. When incidents did happen, the practice learned from them and improved their processes.
  • There were clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse and for identifying and mitigating risks of health and safety.
  • The practice reviewed the effectiveness and appropriateness of the care it provided. It ensured that care and treatment was delivered according to evidence-based guidelines and best practice.
  • Patients received effective care and treatment that met their needs.
  • Patients told us that all staff treated them with kindness and respect and that they felt involved in discussions about their treatment options.
  • Patients considered that staff were friendly and helpful.
  • The practice organised and delivered services to meet patients’ needs. Patients said that they could access care and treatment in a timely way.
  • There were clear responsibilities, roles and systems of accountability to support effective governance.
  • The way the practice was led and managed promoted the delivery of high-quality, person-centre care and contributed to the strong teamwork and high staff morale.
  • The practice took an active part in research projects.
  • There was a strong focus on continuous learning and improvement at all levels of the organisation.

We saw an area of outstanding practice:

  • GPs created a carer’s template with direct hyperlinks to local support agencies and social prescribing. Staff liaised with Age UK to generate a carer’s folder listing local clubs, residential homes, respite homes which was available to all patients.

Details of our findings and the evidence supporting our ratings are set out in the evidence tables.

Dr Rosie Benneyworth BM BS BMedSci MRCGP

Chief Inspector of Primary Medical Services and Integrated Care.

Inspection carried out on 29 January 2016

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Arden Medical Centre on 29 January 2016. Overall the practice is rated as outstanding.

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

  • Throughout our inspection we noticed a strong theme of positive feedback from staff, patients and other organisations who worked with the practice. Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • There were consistently high levels of constructive staff engagement. The practice recognised and celebrated staff innovation and hard work. The management team worked closely together to motivate and encourage staff to succeed.

  • Risks to patients were assessed and well managed. Patients’ needs were assessed and care was planned and delivered following best practice guidance. The practice had clearly defined and embedded systems, processes and practices in place to keep people safe and safeguarded from abuse.

  • The practice was proactive in identifying and managing significant events. All opportunities for learning from internal and external incidents were maximised.

  • The practice had an effective programme of continuous clinical and internal audits. The audits demonstrated quality improvement and improvements to patient care and treatment. Staff were actively engaged in activities to monitor and improve quality and patient outcomes

  • The practice used innovative and proactive methods to improve patient outcomes and working with other local providers to share best practice. The practice was committed to working collaboratively and worked closely with other organisations in planning how services were provided to ensure that they meet patients’ needs.

  • All patients who were registered with the practice had a named GP and patients could access appointments and services in a way and at a time that suited them.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a consequence of feedback from patients and from the patient participation group.

  • The practice had a clear vision which had quality and safety as its top priority. We observed a strong patient-centred culture and we saw that staff treated patients with kindness and respect, and maintained confidentiality.

  • The practice had a regular programme of practice meetings and there was an overarching governance framework which supported the delivery of the practice’s strategy and good quality care. Governance and performance management arrangements were proactively reviewed to reflect best practice.

  • We observed the premises to be visibly clean and tidy. The practice had good facilities and was well equipped to treat patients and meet their needs. The practice took a proactive approach to the management of infection control; they operated a comprehensive programme of infection control audits, infection control spot checks and involved the CCG infection control lead in the induction programme for new staff.

We saw some areas of outstanding practice:

  • The practice took a proactive approach to understanding the needs of different groups of people. This included patients experiencing poor mental health (including dementia) and in vulnerable circumstances. Opportunistic screening was undertaken for dementia during flu clinics. The practice had approached a local psychiatrist (who specialises in problems relating to learning disabilities) in order to implement a memory screening assessment form to identify problems with memory and potential dementia for their patients with a learning disability; so that further support and treatment could be arranged as appropriate.

  • The involvement of other organisations and the local community was integral to how services were planned to ensure that services meet people’s needs. An in-house dermatology nurse worked with the practice to offer services such as cryotherapy twice a month. The practice was also a host site for consultant ear, nose and throat (ENT) clinics whereby an ENT consultant worked with the practice every other week. The practice was also focusing on how they could treat leg ulcers in the wider community through offering a tissue viability nursing service.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice