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Archived: Glenpark Medical Centre Good

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Inspection Summary


Overall summary & rating

Good

Updated 5 September 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Glenpark Medical Centre on 25 May 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 to report incidents and near misses. All opportunities for learning from internal and external incidents were maximised.
  • Risks to patients were assessed and well managed.
  • The practice carried out clinical audit activity and were able to demonstrate improvements to patient care as a result of this.
  • Feedback from patients about their care was consistently positive. Patients reported that they were treated with compassion, dignity and respect.
  • Urgent appointments were usually available on the day they were requested. Pre- bookable appointments were available within acceptable timescales.
  • The practice had a number of policies and procedures to govern activity, which were reviewed and updated regularly.
  • The practice had proactively sought feedback from patients and had an active patient participation group. The practice implemented suggestions for improvement and made changes to the way they delivered services in response to feedback.
  • The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness.
  • Information about services and how to complain was available and easy to understand.
  • The practice had a clear vision in which quality and safety was prioritised. The strategy to deliver this vision was regularly discussed and reviewed with staff and stakeholders.

We saw several areas of outstanding practice. This included:

  • The development of an integrated baby clinic with the local NHS Foundation Trust. This was staffed by a GP and a nurse from the practice together with a health visitor and nursery nurse employed by the trust. Parents therefore had access to a multi-disciplinary team of practitioners and services to help them care for their child, which included a weekly drop in service. The clinic was well attended and patient feedback about the service on the day of our inspection was overwhelmingly positive.
  • The practice was proactive in their identification of, and support offered to carers, including young carers. They had identified 3.5% of their patient population as being a carer which included 36 young carers.
  • The practice was performing well and the highest performing practice in Gateshead as at 31 March 2016 in terms of ensuring that eligible patients had received a flu vaccination. 94% of their eligible patient population had been vaccinated.

However, there were some areas where the provider should make improvements.

The provider should:

  • Introduce a significant event policy as an aid for staff unfamiliar with the process
  • Review their induction checklist to include training on infection control and handwashing techniques

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 5 September 2016

The practice is rated as good for providing safe services.

Nationally reported data we looked at as part of our preparation for this inspection did not identify any risks relating to safety. Staff understood and fulfilled their responsibilities with regard to raising concerns, recording safety incidents and reporting them both internally and externally. Risks to patients were generally assessed and well managed.

Lessons were shared to make sure action was taken to improve safety in the practice.

When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, and verbal or written apologies.

The practice was clean and hygienic and good infection control arrangements were in place.

There was evidence of effective medicines management and the medicines we checked were in date and stored appropriately. The practice had an effective system in place to monitor the use and movement of blank prescriptions.

Comprehensive staff recruitment and induction policies were in operation and staff had received Disclosure and Barring Service (DBS) checks where appropriate. Chaperones were available if required and staff who acted as chaperones had undertaken appropriate training. The availability of the chaperone service was advertised in the waiting room and on the practice website.

Effective

Good

Updated 5 September 2016

The practice is rated as good for providing effective services.

Patients’ needs were assessed and care was planned and delivered in line with current legislation. Arrangements had been made to support clinicians with their continuing professional development. There were systems in place to support multi-disciplinary working with other health and social care professionals in the local area. Staff had access to the information and equipment they needed to deliver effective care and treatment and had received training appropriate to their roles.

Data from the Quality and Outcomes Framework showed patient outcomes were better than local clinical commissioning group (CCG) and national averages. The practice used the Quality and Outcomes Framework (QOF) as one method of monitoring effectiveness and had achieved 100% of the point’s available (local CCG average 95.5% and national average 94.7%) for the period 2014/15 (the most recently published data). For 2015/16 the practice was able to demonstrate that they had achieved 99.7%.

Achievement rates for cervical screening, flu vaccination and the majority of childhood vaccinations were above or comparable with local and national averages. For example, at 81%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was comparable with the CCG average of 81% and national average of 82%. Childhood immunisation rates for the vaccinations given to two year olds ranged from 76% to 98.1% (compared with the CCG range of 81.3% to 97%). For five year olds this ranged from 91.8% to 100% (compared to CCG range of 89.8% to 97.9%). As at 31 March 2016 the practice was the highest performing practice in the Gateshead area in relation to ensuring eligible patients were vaccinated against flu (94% of eligible patients). The practice was also the fourth highest achieving practice in the local CCG area in terms of bowel cancer screening.

There was evidence of clinical audit activity and improvements made as a result of this. Staff received annual appraisals and were given the opportunity to undertake both mandatory and non-mandatory training.

Caring

Good

Updated 5 September 2016

The practice is rated as good for providing caring services.

Patients we spoke with during the inspection and those that completed Care Quality Commission comments cards said they were treated with compassion, dignity and respect and they felt involved in decisions about their care and treatment. Information for patients about the service was available. We saw that staff treated patients with kindness and respect, and maintained confidentiality.

Results from the National GP Patient Survey published in January 2016 were comparable with local CCG and national averages in respect of providing caring services. For example, 91% of patients who responded to the survey said the last GP they saw or spoke to was good at listening to them (CCG average 91% and national average 89%) and 90% said the last nurse they saw or spoke to was good at listening to them (CCG average 92% and national average was 91%).

Results also indicated that 83% of respondents felt the GP treated them with care and concern (CCG average 88% and national average of 85%). 90% of patients felt the nurse treated them with care and concern (CCG average 92% and national average 91%).

The practice was proactive in the identification and support of carers, including young carers. The practice had employed an apprentice as a social prescriber whose role including signposting patients at risk of social isolation to relevant support services such as the local befriending service.

Responsive

Good

Updated 5 September 2016

The practice is rated as good for providing responsive services.

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 that the practice responded quickly to issues raised. Trends and themes arising from complaints and significant events were identified and implementation of lessons learned monitored appropriately. The practice was proactive in ensuring that all significant events were reported to the local CCG using the Safeguard Incident and Risk Management (SIRMS) system. This enabled not only the practice but the CCG to identify recurrent issues and those requiring immediate remedial action.

The practice’s scores in relation to access in the National GP Patient Survey were lower than local and national averages. Then most recent results (January 2016) showed that 81% of patients were able to get an appointment to see or speak to someone the last time they tried (CCG average 85%, national average 85%). 60% found it easy to get through to the surgery by phone (CCG average 78%, national average 73%). 66% said they usually waited 15 minutes or less after their appointment time (CCG average 68%, national average of 65%). However, the practice was aware of patient dissatisfaction in these areas and were committed to taking appropriate action to improve.

The practice was able to demonstrate that they continually monitored the needs of their patients and responded appropriately. The practice had become involved in a number of initiatives to improve services. For example:

  • They were participating in a home visit pilot to ensure that frail, housebound and hard to reach patients could be seen without delay. This ensured that home visits could be carried out up to 8pm on weekdays and from 8am to 2pm on a weekend.
  • They had developed the Year of Care approach to treating patients with long term conditions. This ensured that patients with comorbidities were offered one fully comprehensive annual review, involved in their care planning and given a copy of their care plan which including results of tests and an explanation of what this meant. The Year of Care Partnership were in the process of using Glenpark as an example of how to implement effective care and support planning for patients with long term conditions.
  • They had developed an integrated baby clinic in conjunction with the local NHS Foundation Trust which was staffed by multi-agency practitioners including a practice GP and nurse
  • Employed a frailty nurse in conjunction with 3 other local GP practices
  • Employed an apprentice as a social prescriber
  • Patients with a learning disability were able to receive flu vaccinations and a fully comprehensive annual review in their own homes carried out by a joint visit by a practice GP and a district nurse.

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. For example, they had made changes to how they delivered their baby clinic as a result of patient feedback.

Well-led

Good

Updated 5 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 this.

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 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 practice had a formal business plan and there was evidence of business development discussions taking place and being shared with the whole staff team.

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 in place for knowing about notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken.

The practice proactively sought feedback from staff and patients, which it acted on. An active patient participation group was in operation

There was a strong focus on continuous learning and improvement at all levels.

Checks on specific services

People with long term conditions

Good

Updated 5 September 2016

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

Longer appointments and home visits were available when needed. The practice’s computer system was used to flag when patients were due for review. This helped to ensure the staff with responsibility for inviting people in for review managed this effectively. Patients with multiple long term conditions were offered a comorbidity review in their birthday month.

The practice were proactive in their treatment of diabetes and cared for 91% of their patients in-house by offering an insulin initiation service. They participated in the National Diabetes Audit and had achieved higher than the local CCG average for caring for patients with Type 1 and Type 2 diabetes. The practice was also committed to improving the engagement of patients with asthma. They had commissioned marketing expertise to redesign review invitation letters and encourage more patients to respond.

Nationally reported Quality and Outcomes Framework (QOF) data (2014/15) showed the practice had achieved very good outcomes in relation to the conditions commonly associated with this population group. For example:

  • The practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with asthma. This was 3.46% above the local CCG average and 2.6% above the national average.
  • The practice had obtained 100% of the point available to them in respect of chronic obstructive pulmonary disease. This was 3% above the local CCG average and 4% above the national average
  • The practice had obtained 100% of the points available to them in respect of hypertension (2.2% above the local CCG average and 2.2% above the national average).
  • The practice had obtained 100% of the points available to them in respect of diabetes (8% above the local CCG average and 10.8% above the national average).

Families, children and young people

Good

Updated 5 September 2016

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

The practice had identified the needs of families, children and young people, and put plans in place to meet them. There were processes in place for the regular assessment of children’s development. This included the early identification of problems and the timely follow up of these. Systems were in place for identifying and following-up children who were considered to be at-risk of harm or neglect. For example, the needs of all at-risk children were regularly reviewed at practice multidisciplinary meetings involving child care professionals such as health visitors.

Appointments were available outside of school hours and the premises were suitable for children and babies. Arrangements had been made for new babies to receive the immunisations they needed. Vaccination rates for 12 month and 24 month old babies and five year old children were comparable with national averages. For example, childhood immunisation rates for the vaccinations given to two year olds ranged from 76% to 98.1% (compared with the CCG range of 81.3% to 97%). For five year olds this ranged from 91.8% to 100% (compared to CCG range of 89.8% to 97.9%). Systems were in place to follow up children who repeatedly failed to attend immunisation appointments and highlight concerns to the local safeguarding authority.

At 81%, the percentage of women aged between 25 and 64 whose notes recorded that a cervical screening test had been performed in the preceding five years was comparable with the CCG average of 81% and national average of 82%.

In conjunction with South Tyneside Foundation NHS Trust the practice had developed an integrated baby clinic. This was staffed by a GP and nurse from the practice together with a health visitor and nursery nurse employed by the trust. This ensured that parents had access to a multi-disciplinary team of practitioners to help them care for their child. Services offered at the clinic included a ‘stay and play’ area, development and behaviour advice, advice on feeding and weaning, immunisations and post-natal checks combined with 6 week checks for babies. Pregnant women were able to access antenatal services twice per week.

There was a dedicated area for young people on the practice website. This gave young people access to relevant health information and videos, including sexual health and contraception and information for young carers with links to a young carers website.

Older people

Good

Updated 5 September 2016

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

Nationally reported data showed the practice had good outcomes for conditions commonly found amongst older people. For example, the practice had obtained 100% of the points available to them for providing recommended care and treatment for patients with heart failure. This was above the local clinical commissioning group (CCG) average of 97.9% and the England average of 97.9%.

Patients aged over 75 had a named GP and the practice offered flu immunisations to older people which included home visits for any housebound patients considered to be at risk. The practice had a palliative care register and held regular multi-disciplinary meetings to discuss and plan end of life care. This involved the development of emergency health care plans in conjunction with patients and their families and carers. The practice had ensured that all 1219 of their patients over the age of 65 had been offered and either received or declined a flu vaccination as at 31 March 2016. Comprehensive care plans were in place for the 2% of the practice patient population most at risk of unplaned admission to hospital. Together with three other GP practices based in the inner West locality of Gateshead the practice had employed a frailty nurse. The role of the frailty nurse was to deliver targeted, proactive and reactive care to elderly patients to enable them to stay in their own homes and avoid unplanned admission to hospital.

All local care homes in which the practice had patients had a named link GP to enable continuity of care. The practice operated a ward round approach to visiting patients in their main care home in conjunction with an elderly care specialist nurse.

The practice was participating in a home visit pilot to ensure that frail, housebound and hard to reach patients could be seen without delay. This ensured that home visits could be carried out up to 8pm on weekdays and from 8am to 2pm on a weekend. The practice had employed an apprentice as a social prescriber. Their role involved contacting any patient a practice clinician felt was suffering from social isolation to discuss their needs and signpost them to appropriate support organisations such as a local befriending service.

Working age people (including those recently retired and students)

Good

Updated 5 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 met. The main surgery was open from 7am to 6pm on a Monday and Thursday, 8.30am to 6pm on a Tuesday and Friday and 8.30am to 8pm on a Wednesday. The branch surgery was open from 8.30am to 12 midday on a Monday to Friday as well as 4.30pm to 6pm on a Wednesday. Patients registered with the practice are able to access appointments at either surgery. The practice also offered pre bookable telephone consultations to aid patients who worked or were unable to physically attend the surgery. Pre bookable appointments were also available at one of three local extended access ‘hubs’.

The practice offered minor surgery, contraceptive services (including implants, injections and insertion of intrauterine devices), travel health clinics, smoking cessation and NHS health checks (for patients aged 40-74).

The practice was proactive in offering online services as well as a full range of health promotion and screening which reflected the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 5 September 2016

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

Nationally reported QOF data for 2014/15 showed the practice had achieved the maximum point available to them for caring for patients with dementia, depression and mental health conditions. At 91.3% the percentage of patients diagnosed with dementia whose care had been reviewed in a face to face meeting in the last 12 months was 5.3% above the local CCG and 7.3% above the national average.

Patients on the practice mental health register were offered annual reviews. Patients experiencing poor mental health were sign posted to various support groups and third sector organisations, such as local wellbeing and psychological support services.

Patients known to have self-harmed or attempted suicide were contacted to encourage them to make an appointment with a GP.

The practice had employed an apprentice as a social prescriber who would contact any patient a practice clinician felt was suffering from social isolation to discuss their needs and signpost them to appropriate organisations such as a local befriending service.

People whose circumstances may make them vulnerable

Good

Updated 5 September 2016

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

The practice held a register of patients living in vulnerable circumstances, including those with a learning disability. Longer appointments were available for patients with a learning disability, who were also offered an annual flu immunisation and health review. The annual review was either conducted in the patient’s own home by a joint visit from a GP and a district nurse or at the practice where the patient was given a half hour appointment with a GP followed by 20 minutes with a practice nurse.

The practice had established effective working relationships with multi-disciplinary teams in the case management of vulnerable people. 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 and out of hours.

The practice pro-actively identified carers, including young carers and ensured they were offered appropriate advice and support. At the time of our inspection they had identified 320 of their patients as being a carer (approximately 3.5% of the practice patient population). This included the identification of 36 young carers.

The practice was in the process of working towards the Accessible Information Standard to ensure that disabled people have access to information they are able to read and understand and are supported in communicating.