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Stenhouse Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 12 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Stenhouse Medical Centre on 13 July 2016. Overall the practice is rated as good.

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

  • The practice demonstrated an open and transparent approach to safety. There were systems in place to enable staff to report and record significant events. Learning from significant events was shared with relevant staff.
  • Risks to patients were assessed and well managed. There were arrangements in place to review risks on an ongoing basis to ensure patients and staff were kept safe.
  • Staff delivered care and treatment in line with evidence based guidance and local guidelines. Training was provided for staff to ensure they had the skills and knowledge required to deliver effective care and treatment for patients.
  • Feedback from patients was that they were treated with kindness, dignity and respect and were involved in decisions about their care.
  • Regular clinical audits were undertaken within the practice to drive improvement.
  • 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 generally found it easy to make an urgent appointment and that staff would always accommodate them where possible.
  • The practice had good facilities and was well equipped to treat patients and meet their needs. Adjustments had been made to the premises to ensure these were suitable for patients with a disability.
  • The practice had mechanisms in place to robustly monitor their performance in respect of access and patient satisfaction. Feedback was proactively sought from staff, patients and stakeholders and acted upon.
  • There was a clear leadership structure which all staff were aware of. Staff told us they felt supported by the partners and management.
  • The provider was aware of and complied with the requirements of the duty of candour.

There was one area where the practice should make improvements:

  • The practice should continue to make efforts to identify and support carers within their patient population

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 September 2016

The practice is rated as good for providing safe services.

  • The practice had systems in place to enable staff to report and record significant events. Staff understood the systems and were encouraged to report events and incidents.
  • Learning from significant events was identified and openly discussed with staff to ensure action was taken to improve safety.
  • When things went wrong patients received support, information and apologies. They were told about actions to improve processes to prevent the same thing happening again.
  • Systems and processes were in place to ensure patients were kept safe and safeguarded from abuse. For example, medicines were managed safely within the practice. The practice had recently developed a new repeat authorisation protocol which it had been asked to share by the clinical commissioning group as an example of good practice.
  • Risks to patients were assessed and generally well managed across the practice.

Effective

Good

Updated 12 September 2016

The practice is rated as good for providing effective services.

  • Nationally reported data showed that outcomes for patients were above local and national averages. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring its effectiveness. The most recently published results showed the practice had achieved 96.8% of the total number of points available. This was 1.7% above the clinical commissioning group (CCG) average and 2.1% above the national average.
  • The practice had a robust recall system in place and did not routinely exempt patients for failing to attend for reviews. The practice had an overall exception reporting rate within QOF of 7.2% which was 1.9% below the CCG average and 2% below the national average. (Exception reporting is the removal of patients from QOF calculations where, for example, the patients are unable to attend a review meeting or certain medicines cannot be prescribed because of side effects).
  • There were systems in place to ensure staff were up to date with relevant guidelines including regular training and clinical meetings. Templates on the patient record system were used to support the delivery of patient care were updated regularly to ensure any changes to guidelines were embedded.
  • Clinical audits were undertaken within the practice to support improvement.
  • 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 12 September 2016

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 several aspects of care. For example, 89% of patients said the last GP they spoke to was good at treating them with care and concern compared to the CCG average of 85% and the national average of 85%.
  • 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.
  • A practice survey of local care homes demonstrated that care home staff felt clinicians from the practice were caring and respectful towards their residents.
  • We saw a range of examples of supporting patients, including delivering medication or prescriptions to patient at home.

Responsive

Good

Updated 12 September 2016

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.
  • Extended hours appointments were available four days per week to meet the needs of the patient population.
  • Significant changes had been made to the practice’s appointment system to meet the needs of the patient population. All calls were logged and patients telephoned back to undergo an initial clinical assessment by telephone. This had improved feedback about access to appointments.
  • Patients said they generally found it easy to make an appointment with a 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 achieved breastfeeding friendly accreditation from their local council in recognition of being a breast feeding friendly place.
  • 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 12 September 2016

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 providing a safe, high quality service.
  • The leadership, governance and culture of the practice were used to drive and improve the delivery of high quality patient centred care.
  • Governance and performance management arrangements supported improvements in the services offered to patients.
  • The practice proactively sought feedback from staff, patients and other stakeholders and used learning and findings to improve the service it offered to patients.
  • There was a clear leadership structure and staff felt supported by management.
  • The patient participation group (PPG) was active and met regularly; they worked closely with the practice to identify areas for improvement and supported them to make improvements. For example, the PPG had been involved in the improvement of lighting in the entrance area of the practice.
  • There was a strong focus on continuous learning and improvement at all levels.
Checks on specific services

People with long term conditions

Good

Updated 12 September 2016

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

  • Clinical staff had lead roles in managing patients with long-term conditions and those patients identified as being at risk of admission to hospital were identified as a priority.
  • Performance for diabetes related indicators was 86.6% which was 0.7% below the CCG average and 2.6% below the national average. The exception reporting rate for diabetes indicators was 8.9% which was slightly below the CCG average of 10.7% and the national average of 10.8%.
  • Longer appointments and home visits were available when needed to facilitate access for these patients. Homes visits were also undertaken by nursing staff to ensure these patients received regular reviews.
  • All these patients had a named GP and were offered regular reviews to check their health and medicines needs were being met.
  • For patients with more complex needs, the named GP worked with relevant health and social care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 12 September 2016

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

  • Systems were in place to identify children at risk. The practice had a dedicated child safeguarding lead staff were aware of who this was.
  • We saw positive examples of joint working with midwives, health visitors and school nurses with regular meetings being held to discuss children at risk.
  • Extended hours appointments were offered four days per week, to ensure appointments were available outside of school hours.
  • A full range of contraception services were available including coil fitting and contraceptive implants.
  • There were toys in the reception area and the practice had received accreditation from the local council as a breastfeeding friendly place.
  • Vaccination rates for childhood immunisations were in line with local averages.

Older people

Good

Updated 12 September 2016

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

  • Personalised care was offered by the practice to meet the needs of its older population. The practice was responsive to the needs of older people, and offered home visits and urgent appointments for those with enhanced needs.
  • Longer appointments were provided for older people as required.
  • The practice worked closely with community teams to ensure a multidisciplinary package of care was in place for these patients.
  • Feedback from local care homes supported by the practice was positive about the treatment of their residents.
  • The practice was actively working to increase the number of identified carers within their patients population and staff had received recent training from a local carers’ charity.

Working age people (including those recently retired and students)

Good

Updated 12 September 2016

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 offered services which were accessible and flexible. For example extended hours appointments were offered four days per week to facilitate access for working patients.
  • Flexible appointment times could be offered in addition to telephone contact through the practice’s telephone based clinical assessment service.
  • The practice was proactive in offering online services including appointment booking and online prescription services.
  • A range of health promotion and screening services were offered and promoted that reflected the needs of this age group.
  • The practice’s uptake for the cervical screening programme was 83%, which was comparable to the CCG average of 86% and the national average of 82%.
  • A range of services were offered at the practice to facilitate patient access including minor surgery and joint injections.
  • Text messaging was used to confirm appointments and issue reminders.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 September 2016

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

  • Performance for mental health related indicators was 100% which was 6.2% above the CCG average and 7.2% above the national average. The exception reporting rate for mental health related indicators was 18.6% which was above the CCG average of 14.8% and the national average of 11.1%.
  • 96.5% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which was 8.7% above the CCG average and 12.5% above the national average. This exception reporting rate for this indicator was 9.6% which was similar to the CCG average of 9% and the national average of 8.3%.
  • Monthly multidisciplinary meetings were held within the practice to ensure the needs of these patients were being met.
  • The practice had a system in place to follow up patients who had attended A&E who may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia and staff had received dementia awareness training.

People whose circumstances may make them vulnerable

Good

Updated 12 September 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

  • The practice offered longer appointments for patients with a learning disability where required. 84% of patients with a learning disability had received an annual health check in the last 12 months.
  • Information was available which informed vulnerable patients about how to access local and national support groups and voluntary organisations.
  • Translation services were provided where these were required.
  • In order to effectively support vulnerable patients, GPs worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • 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.