Cookham Medical Centre

Updated 4 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Cookham Medical Centre on 11 March 2015. This was the first inspection of the practice.

Overall the practice is rated as good.

Specifically, we found the practice to be good for providing effective, caring, responsive and well led services. However, the practice requires improvement in the provision of safe services and should review the availability of appointments for patients who work. Specifically, control of infection processes need to be improved as do some aspects of monitoring quality and maintaining records.

The practice had undergone a period of significant change during 2014. Two GP partners had left the practice and there had been an interim period before new partners came into post. The practice manager had been in post for eight months. Prior to their coming into post a locum manager had supported the practice.

Our key findings for the practice were:

• Staff understood and fulfilled their responsibilities to raise concerns and report incidents and near misses.
• Staff had a clear understanding of safeguarding both vulnerable adults and children and there were examples of appropriate safeguarding alerts being raised.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment. Information was provided to help patients understand the care available to 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 (PPG).

• 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
• The practice had a firm commitment to training and staff were committed to maintaining and improving their skills and abilities to carry out their roles.

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

Importantly, the provider must:

• Implement a cleaning specification for the practice and monitor cleaning standards. Reduce the risk of cross infection from cleaning equipment by ensuring appropriate segregation of such equipment and undertake a Legionella risk assessment.
• Ensure systems are in place to identify, assess and manage risks to the health, safety and welfare of patients and others and maintain appropriate records that support such systems.

In addition the provider should:

• Ensure that records of all pre-employment checks required by legislation are retained.
• Expand the number of completed clinical audit cycles to monitor clinical quality and systems to identify where action could be taken.
• Consider improved access to appointments for patients of working age and expand the availability of online access to services.
• Review and undertake a risk assessment to determine which emergency medicines should be held in the practice.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 14 May 2015

The practice is rated as good for the care of people with long-term conditions.Nursing staff had lead roles in chronic disease management and patients at risk of hospital admission were identified as a priority. Longer appointments and home visits were available when needed. All these patients had a structured annual review to check that their health and medication needs were being met. Patients with long term conditions told us they received good explanations of their diagnosis and were given advice on self-managing their conditions. For those people with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Updated 14 May 2015

The practice is rated as good for the care of families, children and young people. There were systems in place to identify and follow up children who may be at risk and there was evidence of close working with the local team of health visitors. Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals. They also told us they felt safe bringing their child to see the GPs. Appointments were available outside of school hours and the premises were suitable for children and babies. The practice performance for childhood immunisations met national targets.

Updated 14 May 2015

The practice is rated as good for the care of older people. Nationally reported data showed that outcomes for patients were good for conditions commonly found in older people. The practice offered proactive, personalised care to meet the needs of the older people in its population and provided care for patients living in a number of local care homes. It was responsive to the needs of older people, and offered home visits and rapid access appointments for those with enhanced needs.

Updated 4 July 2016

When we inspected in March 2015 we found concerns relating to accessing appointments for this population group. There were limited online services offered to enable patients to make an appointment or order repeat prescriptions. During our visit in February 2016 we saw evidence that online services  had been implemented since April 2015. The practice had engaged with their patient participation group to promote and encourage use of online services. In addition, in August 2015 an input of funding enabled the practice to offer seven day GP access via a walk-in centre locally. Appointments could be booked through the practice and there was an information leaflet offered to patients with details of how the service worked. This had proved popular and had seen a number of patients utilising this service.

Updated 14 May 2015

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia). Eighty eight per cent of patients experiencing poor mental health had received an annual health check. The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia. A consultant in Psychiatry visited the practice to support GPs in caring for patients with poor mental health. The practice carried out advance care planning for patients with dementia.

The practice offered advice to patients experiencing poor mental health on how to access various support groups and voluntary organisations.

Updated 14 May 2015

The practice is rated as good for the care of people whose circumstances may make them vulnerable. The practice held registers of patients living in vulnerable circumstances including those with a learning disability and carers. It offered annual health checks for patients with a learning disability and over 50% of these patients had received an annual health check.

The practice regularly worked with multi-disciplinary teams in the case management of vulnerable patients. It had told vulnerable patients about how to access various support groups and voluntary organisations. 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.