You are here

Salters Meadow Health Centre Good

Reports


Review carried out on 22 August 2019

During an annual regulatory review

We reviewed the information available to us about Salters Meadow Health Centre on 22 August 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 11 January 2018

During an inspection looking at part of the service

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 carried out on 12 June 2017

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection of Salters Meadow Health Centre on 25 February 2015, the overall rating was Good. The practice was rated as requires improvement for providing well led services and good for providing safe, effective, caring and responsive services. The inspection report can be found by selecting the ‘all reports’ link for Salters Meadow Health Centre on our website at www.cqc.org.uk.

We took action against Salters Meadow Health Centre by issuing a requirement notice in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 (good governance).

This was an unannounced comprehensive inspection on 12 June 2017 carried out to check that improvements had been made (it is policy that if not re-inspected within 12 months, we carry out a comprehensive inspection to re-rate the practice). Overall the practice is now rated as good.

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

  • There was an open and transparent approach to safety and there had been significant improvements in reporting and recording significant events.
  • The practice had some systems to reduce risks to patient and staff safety. However further strengthening was required in the following:

  • Regular fire evacuation drills were not completed.
  • Improve signage to advise patients on the availability of chaperones.
  • Recruitment checks on staff employed were incomplete.
  • The system for managing alerts to minimise risk to the safety of patients and staff did not include a check to ensure actions required had been completed.
  • Safeguarding systems for adults and children.
  • There had been no assessment on which emergency medicines should be carried as routine when performing home visits.

  • There was a system for managing repeat medicines. However this did not comply with nationally recognised guidelines for accepting medicines requests by telephone.

  • Staff were aware of clinical guidelines for providing treatment. However there was no systematic approach to ensure treatment was carried out in line with current evidence based guidance.
  • Patients with long term conditions were effective managed using the Quality and Outcomes Framework. However there was no system to invite elderly patients and patients with learning disabilities for annual health checks.
  • Clinical staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. However there was no formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice were in place.
  • The provider had a training programme that included all staff. We saw that mandatory training requirements for non-clinical staff had been completed or planned.
  • Results from the national GP patient survey published in July 2016 generally showed above average scores when patients were asked if they were treated with compassion, dignity and respect and were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available. Improvements were made to the quality of care as a result of complaints and concerns. Verbal complaints were not always recorded or collated therefore missed opportunities to further improve care. At this inspection we were told by patients and staff that the availability of appointments was becoming a common cause for complaint.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff spoke positively about the support from the GP partners and management team.
  • The practice proactively sought feedback from staff and patients, which it acted on.

Importantly, the practice must:

  • Complete regular fire evacuation drills.
  • Improve safeguarding systems for adults and children.
  • Review the system for managing alerts to include a check that appropriate action has been taken.
  • Revise the policy for accepting repeat medicine requests by telephone.
  • Ensure all appropriate recruitment checks are carried out on staff and implement processes to demonstrate that the physical and mental health of newly appointed staff have been considered to ensure they are suitable to carry out the requirements of the role.
  • Complete a risk assessment to determine which medicines should be routinely carried when performing home visits.

The areas where the provider should make improvement are:

  • Implement a structured approach to invite elderly patients for annual health checks.
  • Implement a formal system to review nurse/patient consultation and prescribing records to ensure the competence and safety of nurses employed to work at the practice were in place.
  • Consider additional signage to advise patients on the availability of chaperones.
  • Implement a system to monitor adherence to clinical guidelines.
  • Complete regular appraisals for all staff to include identification of training needs additional to the mandatory courses.
  • Review the process for recording verbal complaints to allow trends to be identified and actioned.
  • Consider a review of the current clinical rota pattern in to include capacity planning.
  • Consider introducing a call/recall system to invite patients on the learning disability register for annual health checks.


Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection carried out on 25 February 2015

During a routine inspection

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Salters Meadow Health Centre on 25 February 2015. Overall the practice is rated as good.

Specifically, we found the practice to be good for providing safe, effective, caring and responsive services. It was also good for providing services for older people; people with long-term conditions; families, children and young people; working age people; people whose circumstances may make them vulnerable and people experiencing poor mental health. It required improvement for providing well led services.

Our key findings were as follows:

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • The practice offered good continuity of care as all patients had a named GP. However some patients told us they had experienced difficulty in accessing appointments with GPs.
  • Staff understood and fulfilled their responsibilities to raise concerns, and to report incidents and near misses. However, information about safety was not always recorded, monitored, appropriately reviewed and addressed.
  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned. However, records were not available to support this.

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

Importantly, the provider must:

  • Ensure the methods used for review and dissemination of learning from significant events, near misses and complaints are robust.

In addition the provider should:

  • Ensure the risks to patients and staff from infection control are minimised by completing, recording and acting upon findings from regular infection control audits.
  • Introduce regular staff meetings to support and involve all practice staff.
  • Ensure that accurate records of meetings are kept.
  • Ensure that staff are aware of and identify with the practice vision and values
  • Ensure outcomes from the innovative projects the practice is involved are collated as part of quality improvement work.
  • Ensure all training is recorded.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice