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Salters Meadow Health Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 12 February 2018

Letter from the Chief Inspector of General Practice

We previously carried out an announced comprehensive inspection at Salters Meadow Health Centre Health Centre on 12 June 2017. The overall rating for the practice was good with requires improvement in safe. The full comprehensive report on the 12 June 2017 inspection can be found by selecting the ‘all reports’ link for Salters Meadow Health Centre on our website at www.cqc.org.uk.

This inspection was an announced focused inspection carried out on 11 January 2018 to confirm that the practice had carried out their plan to meet the legal requirements in relation to the breaches in regulations that we identified in our previous inspection on 12 June 2017. This report covers our findings in relation to those requirements and also additional improvements made since our last inspection.

Overall the practice is now rated as Good.

Our key findings were as follows:

  • The practice had ensured that fire evacuation drills were planned and undertaken.

  • Safeguarding systems for adults and children were in place. The practice had also introduced electronic read codes to enable the practice to readily complete patient searches. These were specific to the practice rather than the use of codes suggested by the Royal College of General Practitioners (RCGP) which would enable continuity should a patient relocate.

  • A system for managing patient safety alerts which included a check that appropriate action has been taken had been implemented.

  • The practice had ceased accepting repeat medicine requests by telephone and completed a risk assessment to determine which medicines should be routinely carried when performing home visits.

  • The practice had implemented processes to demonstrate that the physical and mental health of newly appointed staff had been considered to ensure they were suitable to carry out the requirements of the role.

  • The practice was recruiting to their practice nursing team at the time of the inspection. This was due to staff choice in reducing their clinical hours and retirement this meant appointment capacity had reduced in the short term and winter pressure demands had increased.

    We also saw the following best practice recommendations we previously made in relation to providing services had been actioned/addressed:

  • Elderly patient’s annual health check reviews were being implemented with a structured approach with the application of the practice frailty register which was an ongoing process.

  • A formal system to review nurse/patient consultation and prescribing records had been implemented to ensure the competence and safety of nurses employed to work at the practice.

  • Signage to inform patients on the availability of chaperones was evident.

  • The practice clinical meeting agenda included clinical guidance updates to assist in the monitoring of adherence to clinical guidelines.

  • The regular appraisals for all staff included the identification of training needs additional to the mandatory courses.

  • The process for recording verbal complaints had been reviewed which enabled any trends to be identified and actioned.

  • The GP clinical rota pattern included capacity planning and the practice demonstrated that an additional four appointment slots per GP had been enabled with the successful recruitment of GP partners.

However, there were also areas of practice where the provider needs to make improvements.

The provider should:

  • Consider a system to monitor and risk assess both clinical and non-clinical staff immunisation and vaccination histories.

  • Implement the recall system to invite patients on the learning disability register for annual health checks.

  • Consider the use of the Royal College of General Practitioners (RCGP) electronic safeguarding read codes.

At our previous inspection on 12 June 2017, we rated the practice as requires improvement for providing a safe service an example of one of the improvements to be made was to implement a call/recall system to invite patients on the learning disability register for annual health checks. At this inspection we found that this system had been discussed but had still not been introduced. The practice had advised that recruitment of staff and staff changes had impacted on their ability to achieve this since the last inspection in June 2017. The practice had since recruited two new GP partners and was interviewing for practice nurses the week of the inspection. They assured us that patients on the learning disability register would be invited for annual health checks before the end of the year.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 February 2018

Effective

Good

Updated 12 February 2018

Caring

Good

Updated 12 February 2018

Responsive

Good

Updated 12 February 2018

Well-led

Good

Updated 12 February 2018

Checks on specific services

People with long term conditions

Good

Updated 20 July 2017

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

  • Patients at risk of hospital admission were identified as a priority.

  • 91% of patients with chronic obstructive pulmonary disease (COPD) had had a review undertaken including an assessment of breathlessness using a recognised scale in the preceding 12 months. This was the same as the CCG average and comparable to the national average of 90%.
  • The percentage of patients with diabetes, on the register, whose last measured total cholesterol was within recommended limits, was 91%. This was comparable to the CCG and national averages of 80%. However the exception reporting rate of 18% was higher than the CCG and national averages of 13% meaning fewer patients had been included.
  • The practice followed up on patients with long-term conditions discharged from hospital and ensured that their care plans were updated to reflect any additional needs.
  • There was a system to recall patients with long term conditions for a structured annual review to check their health and medicines needs were being met. For patients with the most complex needs, the GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.
  • The practice hosted a specialist clinic for patients with diabetes.

Families, children and young people

Good

Updated 20 July 2017

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

  • There were systems and procedures in place to safeguard children from the risk of abuse. Alerts were placed on patient records to make staff aware of children who had a child protection plan in place. However, there was no alert in place to inform staff of the parents or siblings of children with a child protection plan in place.
  • Immunisation rates were relatively high for all standard childhood immunisations.
  • The practice worked with midwives and health visitors to support this population group. For example, in the provision of ante-natal, post-natal and child development clinics.
  • On the day appointments were available for children.
  • There was a system in place to follow up children who did not attend (DNA) for hospital appointments.
  • A contraception service was offered and condoms were available free of charge from the practice.
  • Access was available to male and female clinicians on request.

Older people

Good

Updated 20 July 2017

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

  • Patients aged 75 years or over had a named GP.
  • Elderly patient health checks were provided but there was no call/recall system to invite them to attend for annual health checks.
  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.
  • The practice offered proactive, personalised care to meet the needs of the older patients in its population. For example, the advance nurse practitioner would visit elderly patients in their homes to administer flu vaccinations.
  • The practice was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice followed up older patients discharged from hospital and liaised with GPs and district nursing staff so that patients’ care plans were updated to reflect any extra needs.
  • The practice identified older patients who needed palliative care as they were approaching the end of life. It involved older patients in planning and making decisions about their care, including their end of life care.

Working age people (including those recently retired and students)

Good

Updated 20 July 2017

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

  • The needs of this population group had been identified and the practice had adjusted the services it offered to respond to patients’ needs. Appointments outside of core working hours were available at the practice and telephone consultations were available for working age people.
  • The practice was proactive in offering online services as well as a full range of health promotion and screening that reflected the needs for this age group.
  • The provider offered NHS Healthchecks and had completed 1,584 out of an eligible population of 2,021 in the last five years.

People experiencing poor mental health (including people with dementia)

Good

Updated 20 July 2017

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

  • The practice had identified a similar percentage of their patients as having dementia (0.8%) when compared to the national average (0.8%).
  • The practice carried out advance care planning for patients living with dementia.
  • The practice hosted an in-house clinic from a counsellor for minor mental health conditions.
  • 84% of patients diagnosed with dementia had a care plan in place that had been reviewed in a face-to-face review in the preceding 12 months. This was lower than the Clinical Commissioning Group (CCG) average of 88% but the same as the national average.
  • The practice had a system for monitoring repeat prescribing for patients receiving medicines for mental health needs.
  • 89% of patients with a diagnosed mental health condition had a comprehensive, agreed care plan documented in their record, in the preceding 12 months. This was the same as the CCG and national averages. However the exception reporting rate of 22% was higher than the CCG average of 16% and national average of 13% meaning fewer patients had been included.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.
  • Staff were aware of where to refer patients for supporting services. For example, the early intervention team for patients who experienced psychotic symptoms.
  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Requires improvement

Updated 20 July 2017

The practice is 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 carers and those with a learning disability. There was a register of 39 patients with learning disabilities but the practice had no patient call/recall system to invite these patients for annual health checks. No health checks had been completed in 2016/17.
  • End of life care was delivered in a coordinated way which took into account the needs of those whose circumstances may make them vulnerable.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients.
  • The practice had information available for vulnerable patients about how to access various support groups and voluntary organisations.
  • Staff interviewed knew how to recognise signs of abuse in children, young people and adults whose circumstances may make them vulnerable. They were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies.
  • A translation service was available and a hearing loop was available at the reception desk.
  • The building had disabled facilities which included automated entrance doors to the building.