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Far Lane Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 12 June 2017

Letter from the Chief Inspector of General Practice

This practice was previously inspected by the Care Quality Commission (CQC) in March 2016 and rated good with requires improvement for safe. Enforcement action was taken and requirement notices issued with regard to Regulation 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations. The link to this report can be found by selecting the ‘all reports’ link for Far Lane Medical Centre on our website at www.cqc.org.uk. A focused follow up inspection was programmed on 20 February 2017 to review in detail the actions taken by the practice to improve the quality of care and to confirm that the practice was meeting legal requirements. The requirement notices had not been met so we scheduled a comprehensive inspection.

We carried out an announced comprehensive inspection at Far Lane Medical Centre on 26 April 2017. Overall the practice is rated as good.

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

  • The practice had systems in place to minimise risks to patient safety.
  • There was an open and transparent approach to safety and a system in place for reporting and recording significant events. However, there was limited evidence of reported incidents and lessons learned were not communicated widely enough to support improvement.

  • Staff were aware of current evidence based guidance. Staff had been trained to provide them with the skills and knowledge to deliver effective care and treatment. There were some shortfalls with regard to chaperone training of staff who worked at the branch site and infection control training.

  • Results from the national GP patient survey showed patients 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 and easy to understand.
  • Patients we spoke with said they found it difficult to access the practice by telephone to make an appointment though access to urgent appointments the same day were available when required.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • There was a clear leadership structure and staff felt supported by management. The practice sought feedback from staff and patients, which it acted on.
  • The provider was aware of the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • Ensure staff who perform chaperone duties at the branch site are trained for the role.

  • Encourage staff to report significant events and ensure lessons learned are communicated widely enough to support improvement.

  • Review the system for monitoring of cleaning schedules.

  • Review ways to identify carer’s and add them to the carer’s register to be able to offer them support.

  • Consider patient feedback regarding telephone access and implement the action plan for improvement as soon as practicable.

  • Monitor the system implemented to improve security and track blank prescription forms.

Professor Steve Field CBE FRCP FFPH FRCGP 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 12 June 2017

The practice is rated as good for providing safe services.

  • There was a system in place for reporting and recording significant events and from the incident we reviewed action was taken to improve safety in the practice. However, there was limited evidence of reported incidents and lessons learned were not communicated widely enough to support improvement. Staff we spoke with could not recall discussing any recent incidents.

  • The practice had systems, processes and practices to minimise risks to patient safety.

  • Staff demonstrated that they understood their responsibilities and all had received training on safeguarding children and adults relevant to their role.

  • The practice had adequate arrangements to respond to emergencies and major incidents.

Effective

Good

Updated 12 June 2017

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework showed patient outcomes were at or above average compared to the national average.

  • Staff were aware of current evidence based guidance.

  • Clinical audits demonstrated quality improvement.

  • Staff had the skills and knowledge to deliver effective care and treatment although there were some gaps with regard to infection control and chaperone training.

  • 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.

  • End of life care was coordinated with other services involved.

Caring

Good

Updated 12 June 2017

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice slightly lower than others in the locality for several aspects of care. However, 98% of patients said they had confidence and trust in the last GP they saw compared to the CCG average of 96% and the national average of 95%.

  • Patients we spoke with 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 accessible.

  • The practice’s computer system alerted GPs if a patient was also a carer. The practice had identified 63 patients as carers (0.8% of the practice list). The GP told us the practice was looking at ways to improve the accuracy of the carer’s register. Written information was available to direct carers to the various avenues of support available to them.

  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.

Responsive

Good

Updated 12 June 2017

The practice is rated as good for providing responsive services.

  • The practice understood its population profile and had used this understanding to meet the needs of its population.

  • Patients we spoke with said they were happy with the care they received though found it difficult to access the practice by telephone to make an appointment. Urgent appointments were available the same day for those that required one.

  • The practice had good facilities and was well equipped to treat patients and meet their needs.

  • Information about how to complain was available and evidence from two examples reviewed showed the practice responded quickly to issues raised though there was limited opportunity for staff learning from these. The practice manager told us complaints would be discussed at the full team meeting should there be any lessons to be learned from individual complaints and to review analysis of trends.

Well-led

Good

Updated 12 June 2017

The practice is rated as good for being well-led.

  • The practice had a 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 it.

  • There was a clear leadership structure and staff felt supported by management. The practice had policies and procedures to govern activity and held regular governance meetings.

  • An overarching governance framework supported the delivery of the strategy and good quality care. This included arrangements to monitor and improve quality and identify risk.

  • Staff had received inductions, annual performance reviews and attended staff meetings and training opportunities.

  • The provider was aware of the requirements of the duty of candour.
  • The partners encouraged a culture of openness and honesty.

  • The practice sought feedback from staff and patients.

  • There was a focus on continuous learning and improvement at all levels within the practice. The practice had recently appointed a new practice manager and a HR consultancy firm to review the practices' policies and procedures. Gaps in staff training had been identified and training arranged and significant events had been added as a standard agenda item to the full team meeting agenda for learning and development.

Checks on specific services

People with long term conditions

Good

Updated 12 June 2017

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

  • Nursing staff had lead roles in long-term disease management and patients at risk of hospital admission were identified as a priority.

  • 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.

  • All these patients had a named GP and there was a system to recall patients for a structured annual review to check their health and medicines needs were being met. For those patients with the most complex needs, the named GP worked with relevant health and care professionals to deliver a multidisciplinary package of care.

Families, children and young people

Good

Updated 12 June 2017

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

  • There was a system to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of accident and emergency (A&E) attendances.

  • Immunisation rates were relatively high for all standard childhood immunisations.

  • Patients told us, on the day of inspection, that children and young people were treated in an age-appropriate way and were recognised as individuals.

    Appointments were available outside of school hours and the premises were suitable for children and babies.

  • The practice worked with midwives and health visitors to support this population group.

  • The practice had emergency processes for acutely ill children and young people.

  • The practice is Lo-down accredited, which means it aims to support all young people to improve their health and well-being. This is promoted to patients on the practice website. The practice welcomes young people to come and talk to staff about any health-related issues they may have, including all aspects of sexual health, smoking, drug, alcohol issues and healthy eating advice.

Older people

Good

Updated 12 June 2017

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

  • The practice offered proactive, personalised care to meet the needs of the older patients in its population.

  • Staff were able to recognise the signs of abuse in older patients and knew how to escalate any concerns.

  • The practice was responsive to the needs of older patients and offered home visits and urgent appointments for those with enhanced needs.

Working age people (including those recently retired and students)

Good

Updated 12 June 2017

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

  • The needs of these populations had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

  • The practice offered online services as well as a full range of health promotion and screening that reflects the needs for this age group.

People experiencing poor mental health (including people with dementia)

Good

Updated 12 June 2017

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

  • The practice carried out advance care planning for patients living with dementia.

  • Of those patients diagnosed with dementia 92% had had their care reviewed in a face to face meeting in the last 12 months, which is above the CCG average of 85% and national average of 84%.

  • Of those patients diagnosed with a mental health condition, 93% had a comprehensive care plan reviewed in the last 12 months, which is above the CCG average of 90% and national average of 89%.

  • The practice specifically considered the physical health needs of patients with poor mental health and those living with dementia at their annual review appointment.

  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those living with dementia.

  • Patients at risk of dementia were identified and offered an assessment.

  • The practice hosted Improving Access to Psychological Therapies Programme (IAPT) to support patients’ needs.

  • The practice had information available for patients experiencing poor mental health about how they could access various support groups and voluntary organisations.

  • Staff we spoke with had a good understanding of how to support patients with mental health needs and those living with dementia.

People whose circumstances may make them vulnerable

Good

Updated 12 June 2017

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

  • The practice held a register of patients living in vulnerable circumstances including those with a learning disability.

  • 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 offered longer appointments for patients with a learning disability.

  • 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 we spoke with 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 in normal working hours and out of hours.