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Northfield Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 10 February 2017

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Northfield Medical Practice on 2 December 2016. Overall the practice is rated as good for providing safe, effective, caring, responsive and well-led care for all of the population groups it serves.

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

  • The practice staff had a very good understanding of the needs of their practice population and were flexible in their service delivery to meet patient demands; such as providing flexible GP appointments when required.
  • There was a clear leadership structure, staff were aware of their roles and responsibilities and told us the GPs were accessible and supportive.
  • There was evidence of an all-inclusive team approach to providing services and care for patients.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • There was good access to clinicians and patients said they found it easy to make an appointment. There was continuity of care and if urgent care was needed patients were seen on the same day as requested.
  • Patients’ needs were assessed and care was planned and delivered following local and national care pathways and National Institute for Health and Care Excellence (NICE) guidance.
  • The practice promoted a culture of openness and honesty. There was a nominated lead for dealing with complaints and significant events. All staff were encouraged and supported to record any incidents. There was evidence of good investigation, learning and sharing mechanisms in place.
  • Risks to patients were assessed and well managed.
  • There was a safeguarding lead in place and systems to protect patients and staff from abuse.
  • 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 the practice had reviewed access to appointments and improved the telephone system.
  • Staff said they were proud to work at the practice and felt they delivered good, quality service and care to patients.
  • The practice complied with the requirements of the duty of candour. (The duty of candour is a set of specific legal requirements that providers of services must follow when things go wrong with care and treatment.)

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 10 February 2017

The practice is rated as good for providing safe services.

  • Risks to patients were assessed and well managed.
  • There were systems in place for reporting and recording significant events and near misses. There was a nominated lead that ensured all incidents were recorded on the electronic reporting system. There was evidence of investigation, actions taken to improve safety in the practice and shared learning with staff.
  • When things went wrong patients received reasonable support, truthful information, and a written apology. They were told about any actions to improve processes to prevent the same thing happening again.
  • There was a nominated lead for safeguarding children and adults. Systems were in place to keep patients and staff safeguarded from abuse. We saw there was safeguarding information and contact details available for staff.
  • A senior partner attended safeguarding and domestic violence meetings regularly.
  • There were systems in place for checking that equipment was tested, calibrated and fit for purpose.
  • There was a nominated lead for infection prevention and control (IPC). They undertook IPC audits and regular checks of the building.

Effective

Good

Updated 10 February 2017

The practice is rated as good for providing effective services.

  • Staff had the skills, knowledge and experience to deliver effective care and treatment. They assessed the needs of patients and delivered care in line with local and national pathway and NICE guidance.

  • The practice was supported by the local CCG pharmacy advisor to ensure effective prescribing was undertaken.

  • We saw evidence of appraisals and up to date training for staff.

  • There was evidence of working with other health and social care professionals, such as the health visitors, midwife, palliative care nurses, district nurses, community matron and the mental health team, to meet the range and complexity of patients’ needs.

  • GPs met daily to discuss referrals and to access a second clinical opinion to ensure the right referrals were made and best outcomes for patients.
  • Clinical audits demonstrated quality improvement.

  • Services were provided to support the needs of the practice population, such as screening and vaccination programmes, health promotion and preventative care.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were comparable with local and national averages.

Caring

Good

Updated 10 February 2017

The practice is rated as good for providing caring services.

  • Data from the National GP Patient Survey showed patients rated the practice comparable to other practices for the majority of questions regarding the provision of care.
  • Comments we received from patients on the day of inspection were very positive about their care.
  • We observed that staff treated patients with kindness, dignity, respect and compassion. Patients’ comments aligned with these observations..
  • Appropriately trained staff were available to act as chaperones for patients as required.
  • The practice maintained a register of those patients who were identified as a carer and offered additional support as needed.
  • It was apparent when talking with both clinical and administrative staff during the inspection there was a genuine caring and supportive ethos within the practice.

Responsive

Good

Updated 10 February 2017

The practice is rated as good for providing responsive services.

  • The practice worked with NHS East Leicestershire and Rutland (CCG) and other local practices to review the needs of their population.
  • The practice had good facilities and was well equipped to treat patients and meet their needs.
  • National GP patient survey responses and comments made by patients indicated appointments were available when needed.
  • The practice offered pre-bookable and online appointments. All patients requiring urgent care were seen on the same day as requested.
  • They provided access to extended hours services and telephone consultations and text message reminders.
  • The practice could evidence being responsive to demands on the appointment system. They continually audited demand and capacity of appointments.
  • Home visits and longer appointments were available for patients who were deemed to need them, for example housebound patients.
  • There was an accessible complaints system. Evidence showed the practice responded quickly to issues raised and learning was shared with staff.

Well-led

Good

Updated 10 February 2017

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

  • There was a clear leadership structure and a vision and strategy to deliver high quality care and promote good outcomes for patients.
  • There were safe and effective governance arrangements in place. These included the identification of risk and policies and systems to minimise risk.
  • The provider complied with the requirements of the duty of candour. There were systems in place for reporting notifiable safety incidents and sharing information with staff to ensure appropriate action was taken.
  • The practice promoted a culture of openness and honesty. Staff and patients were encouraged to raise concerns, provide feedback or suggest ideas regarding the delivery of services.
  • Staff said they were proud to work at the practice and felt they delivered good, quality service and care to patients.
  • The practice proactively sought feedback from patients through engagement with patients, the Patient Participation Group (PPG) and their local community.
Checks on specific services

People with long term conditions

Good

Updated 10 February 2017

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

  • The practice nurses had lead roles in the management of long term conditions, supported by the GPs.
  • A GP led diabetes clinic was in place with trained nurse and a specialist community diabetes nurse to help ensure coordinated delivery of care.
  • 94% of patients with diabetes had an HbA1C result which was within normal parameters, which was higher than both figures at 93% and 88%. (HbA1c is a blood test which can help to measure diabetes management.)

  • Annual reviews were undertaken to check patients’ health care and treatment needs were being met.
  • 75% of patients diagnosed with asthma had received an asthma review in the last 12 months, compared to 73% locally and 70%nationally.
  • 91% of patients diagnosed with chronic obstructive pulmonary disease (COPD) had received a review in the last 12 months, compared to 89% locally and 90% nationally.

Families, children and young people

Good

Updated 10 February 2017

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

  • The practice worked with midwives and health visitors to support the needs of this population group. For example, the provision, ante-natal, post-natal and child health surveillance clinics.
  • There were systems in place 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 A&E attendances.
  • Immunisation rates were high for all standard childhood immunisations.
  • Patients and staff told us 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. Same day access was available for all children under the age of five.
  • Sexual health, contraceptive and cervical screening services were provided at the practice.
  • 84% of eligible patients had received cervical screening, compared to 79% locally and 76%.nationally.

Older people

Good

Updated 10 February 2017

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

  • Proactive, responsive care was provided to meet the needs of the older people in its population.

  • Registers of patients who were aged 75 years and above and also the frail elderly were in place to ensure timely care and support were provided. Health checks were offered for all these patients.

  • The practice worked closely with other health and social care professionals, via multi-disciplinary care teams. This helped housebound patients receive co-ordinated care and support and reduced hospital admissions.

  • The practice worked with local nursing and care homes providing regular support and guidance.

Working age people (including those recently retired and students)

Good

Updated 10 February 2017

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

  • The needs of these patients 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 provided telephone consultations, online booking of appointments and ordering of prescriptions.
  • Early morning and evening appointments were offered to increase flexibility for working patients.
  • The practice offered a range of health promotion and screening that reflected the needs for this age group.
  • Health checks were offered to patients aged between 40 and 74 who did not have a pre-existing condition. The practice had completed 406 of these health checks which equates to 66% of invited patients who attended.
  • Travel health advice and vaccinations were available.
  • The practice was proactive in offering 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 10 February 2017

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

  • 77% of patients diagnosed with dementia had received a face to face review of their care in the last 12 months, which is comparable to the local and national averages 80% and 83%.
  • Early diagnosis rates of dementia with ability to offer early intervention and support. Results indicate 71% compared to CCG average of 63%.
  • The practice had developed comprehensive care plans for patients with patients diagnosed with dementia.
  • 97% of patients who had a severe mental health problem had received an annual review in the past 12 months and had a comprehensive, agreed care plan documented in their record. This was higher than 94% local and national average of 90%.
  • GP Led substance misuse clinic held at the practice to provide accessible support and advice and offer a range of vaccinations and health screening.
  • Same day appointments / phone consultation were made for patients experiencing poor mental health.
  • Patients and/or their carer were given information on how to access various support groups and voluntary organisations.

People whose circumstances may make them vulnerable

Good

Updated 10 February 2017

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

  • Staff 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.
  • We saw there was information available on how patients could access various local support groups and voluntary organisations.
  • The practice nurse and health care assistant had recently completed updated training to provide annual reviews of care for patients with a learning disability.
  • A GP Led substance misuse clinic was in place to provide accessible support and advice and offer a range of vaccinations and health screening.