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Archived: Haven Medical Centre Good

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Inspection Summary


Overall summary & rating

Good

Updated 6 June 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Haven Medical Centre on 19 April 2016. Overall the practice is 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 an effective system in place for reporting and recording significant events. Learning from events and safety incidents was shared with practice staff.
  • Risks to patients were assessed and well managed.
  • Staff assessed patients’ needs and delivered care in line with current evidence based guidance. The practice was committed to staff training and development and the practice team had the skills, knowledge and experience to deliver high quality care and effective treatment.
  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.
  • Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
  • Patients said they were able to make an appointment with a GP or nurse for the following week, but that it was often difficult to make an appointment with their preferred GP. Urgent appointments were available the same day.
  • 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 proactively sought feedback from staff and patients, which it acted on.
  • There was an active Patient participation Group (PPG) which liaised regularly with the practice to make improvements.
  • The provider was aware of and complied with the requirements of the duty of candour.

The areas where the provider should make improvement are:

  • The practice should ensure that their processes for storing prescription pads is adhered to and monitored.
  • The practice should proactively encourage relevant patients to attend for bowel cancer screening so that uptake is in line with CCG and national averages.
  • The practice should be proactive in identifying patients who are also carers

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 6 June 2016

The practice is rated as good for providing safe services.

  • There was an effective system in place for reporting and recording significant events. Lessons learned were shared with practice staff to improve practice.
  • When any unexpected safety incidents occurred, people were provided with an explanation and an apology. They were told about any actions taken to prevent the same thing happening again.
  • The practice had clearly defined and embedded systems, processes and practices in place to keep patients safe and safeguarded from abuse. All staff had received appropriate safeguarding training and knew how to act if they had a safeguarding concern.
  • The practice had robust recruitment procedures to ensure all staff had the skills and qualifications to perform their roles, and had received appropriate pre-employment checks. A comprehensive induction was provided for all new staff.
  • Risks to patients were assessed and well managed. This included infection control procedures and appropriate checks for systems and, appliances and equipment.
  • Patients on high risk medicines were monitored on a regular basis and actions were taken to review any medicines alerts received by the practice to ensure patients were kept safe.

Effective

Good

Updated 6 June 2016

The practice is rated as good for providing effective services.

  • Data from the Quality and Outcomes Framework (QOF) showed patient outcomes were at or above average compared to the CCG and national averages.
  • Staff assessed needs and delivered care in line with current evidence based guidance and local protocols.
  • Clinical audits demonstrated quality improvement. Two full cycle audits that we looked at showed improvements to care had been made.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment and all GPs had lead roles for clinical areas.
  • There was evidence of personal development plans for all staff which were driven by their annual appraisal. The practice were supportive of development for all staff.
  • Staff worked with a wide range of other health care professionals to understand and meet the range and complexity of patients’ needs.This was supported by monthly multi disciplinary meetings where actions and outcomes were well documented and available for relevant staff.

Caring

Good

Updated 6 June 2016

The practice is rated as good for providing caring services.

  • Data from the national GP patient survey showed patients rated the practice higher than others for several aspects of care.
  • Patients 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 easy to understand and accessible.
  • We saw staff treated patients with kindness and respect, and maintained patient and information confidentiality.
  • The practice had a policy of seeing vulnerable patients on the day they called, in recognition that some patients were difficult to engage with health care. This often meant that additional appointments were made available at the end of the day. An alert was placed in the patients notes to remind reception staff of any special requirements.
  • The community based health care team reported that there was a positive relationship and engagement with the practice team.
  • Feedback from care home staff was consistently positive with regards to the high levels of care provided by the practice team.

Responsive

Good

Updated 6 June 2016

The practice is rated as good for providing responsive services.

  • Practice staff reviewed the needs of its local population and had adjusted services to address the needs. For example; they had increased the GP triaging sessions and had increased the number of routine appointments which could be booked online.
  • They had identified a particular vulnerable group and were looking at how they could work to reduce the number of teenage pregnancies in their area.
  • Patients said they could usually get an appointment when they needed one but that the appointment system for routine care was confusing.This was supported by comments from comments cards we reviewed. Data from the patients survey found that 52% of patients described their experience of making an appointment as good, compared with the CCG which was 73%. Urgent appointments were available the same day. The practice had recognised this as an issue and had been working to improve it. Online booking was being encouraged and routine appointments were constantly monitored and managed.
  • 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 the practice responded quickly to issues raised. Learning from complaints was shared with staff.

Well-led

Good

Updated 6 June 2016

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

  • The partners had a vision to deliver high quality care and promote good outcomes for patients. Staff knew about the vision for the practice and appeared motivated to delivering high quality care.
  • There was a clear leadership structure and governance framework, and staff felt supported by management to deliver the practices vision and values. There were a number of policies and procedures to govern activity, monitor improvement and manage safety
  • 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 notifiable safety incidents and ensured this information was shared with staff to ensure appropriate action was taken
  • The patient participation group was active and worked with the practice to obtain patient feedback and to suggest improvements.
  • There was a strong focus on continuous learning and improvement at all levels and all staff were encouraged to attend the monthly development sessions when the practice closed for an afternoon each month.
  • The partners had identified a need to recruit two further GPs and had worked flexibly and creatively to fill the gap in clinic sessions by recruiting two advanced nurse practitioners to provide clinics for assessment and treatment of minor illness and telephone triage. They had arranged for other nurses to complete additional training which would enable them to prescribe medicines and insert contraceptive devices in the future.
Checks on specific services

People with long term conditions

Good

Updated 6 June 2016

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

  • The practice was committed in supporting the training of clinical staff to deliver chronic disease management and was supporting a nurse to complete a nurse prescribing course. Nursing staff had lead roles in chronic disease management and were supported by the GPs to provide structured annual reviews which incorporated a medicines review and advanced care planning where required. More frequent reviews were provided for those who needed this. There was a dedicated administrator who contacted patients who failed to attend for their appointment. 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.
  • QOF achievements for clinical indicators relating to chronic disease were higher than CCG and national averages. For example, the practice achieved 95% for diabetes related indicators, which was above the local and national averages of 93% and 89% respectively. However, exception reporting was 18% which was 5% higher than the CCG average and 8% higher than the national average. The practice told us that patients whose condition was poorly controlled were being cared for by a local provider which meant that those patients did not attend for regular checks at the practice. These were included in the exception figures.
  • They had provided influenza vaccination for 97% of people with diabetes compared to the national average which was 94%.
  • 94% of patients with diabetes had had a foot examination in the preceding year which was higher than the national average of 88%
  • The practice proactively carried out audits of blood test results and medicine usage to identify patients who may be at risk of developing a chronic disease. Patients who had been identified as being at risk of developing a cardiovascular disease (CVD) were regularly monitored. Telephone advice was provided regarding lifestyle and diet to help prevent long term conditions developing.
  • Longer appointments and home visits were available when needed.
  • Uptake for cancer screening was lower than the CCG and national averages, whilst the number of newly diagnoses cases was similar to both CCG and national averages. However, the practice held a weekly clinical meeting where they discussed any new cancer diagnoses.

Families, children and young people

Good

Updated 6 June 2016

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 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 relatively high for all standard childhood immunisations. For example; attendance for under 24 months ranged between 96% and 99%. Where a child has not attended, the parents are contacted by a health visitor.
  • Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.
  • Appointments were available outside of school hours and the premises were suitable for children and babies. A protocol was in place that ensued that all children requesting an appointment were seen by a clinician on the day.
  • We saw positive examples of joint working with midwives, health visitors and school nurses. Regular meetings were held to discuss families requiring extra support.
  • Antenatal clinics were held three days per week over both sites and postnatal checks were provided for new mothers which included advice on contraception.
  • There was an advanced nurse practitioner ( ANP) who provided contraceptive advice and implanon (contraceptive implant) surgeries in-house for patients. There were plans for the ANP to complete a refresher course on IUCD fitting (contraceptive coil) to increase the capacity to deliver this service.
  • There was an in -house triage protocol that had been developed for all patients and had an additional section for ‘red flag’ symptoms for children. This was to support the reception team in identifying urgency of an appointment. Reception team had also undergone Patient In Need training.

Older people

Good

Updated 6 June 2016

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

  • The practice had higher disease prevalence and higher levels of deprivation affecting their older population. The practice was aware of this and adjusted their services to account for the increased demand for this population.
  • The practice cared for 53 patients in two nursing homes where they provided weekly ward rounds for acute and routine reviews of patients. All new patients admitted to the homes were reviewed within one week of registering at the surgery.
  • The practice used The Gold Standards Framework (GSF) to plan care for older patients at the end of their life. (GSF is a model that enables good practice to be available to all people nearing the end of their lives, irrespective of diagnosis.) Meetings took place on a quarterly basis with community support services, including District Nurses, Community Matrons, Macmillan Nurse, Care Coordinator and Nursing home managers to plan and monitor care. The care co-ordinator tracked patients who had been discharged from hospital to plan their care and co-ordinate services including referral to social care, and voluntary services when required.
  • The practice used RightCare plans to provide clear information on individual needs which were shared with out of hours’ services and other agencies so that care could be coordinated and this helped to reduce the number of unnecessary hospital admissions. The RightCare plans were reviewed annually as a minimum.
  • The practice worked with the CCG pharmacist to review patients medicines and an appointment was arranged annually with a GP for those who were taking more than eight medicines concurrently.
  • All people over 75 had a named GP and routine home visits were provided for housebound patients where required.

Working age people (including those recently retired and students)

Good

Updated 6 June 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 identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.
  • Extended hours surgeries were available and telephone advice via the on call clinician each day during for people who were unable to attend during the usual opening hours.
  • Patients were also able to view their records online and contact the surgery via email.
  • The practice was proactive in offering online services for booking and cancelling appointments and for requesting repeat prescriptions.
  • A full range of health promotion and screening was available that reflects the needs for this age group. For example, there was information regarding breast screening and bowel screening. Health information leaflets were also available for patients to read.
  • Cervical cancer screening had been performed for 81% of eligible women which was 3% below the CCG average and the same as the national average. Exception reporting was 4%.
  • There was a surgery newsletter that kept people up to date with surgery improvements and news.

People experiencing poor mental health (including people with dementia)

Good

Updated 6 June 2016

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

The practice had a population whereby 0.7% of the population had a diagnosis of dementia. Many of these were patients in two local care homes affiliated to the practice which specialised in caring for people with dementia.

  • 86% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the last 12 months, which is comparable to the CCG average and 2% higher than the national average.
  • The practice had a high number of patients receiving care and treatment for complex mental health disorders including alcohol and substance misuse. They had achieved 100% of their QOF points in mental health related indicators which was 3% better than the CCG average and 7% better than the national average, however, the exception reporting across these indicators was 17%. This was the same as the CCG average and 6% higher than the national average.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • The practice carried out advance care planning for patients with dementia, taking account of their best interests, and included carers where relevant.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.
  • The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.
  • Staff had a good understanding of how to support patients with mental health needs and dementia.

People whose circumstances may make them vulnerable

Good

Updated 6 June 2016

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 homeless people, those with a learning disability and those with a mental health condition or dementia, carers and people who were receiving palliative care. All vulnerable people on their registers were invited for an annual health check, apart from those who were receiving palliative care, who were reviewed more frequently as required.
  • The practice offered longer appointments for patients with a learning disability, those with a mental health condition and others who required this.
  • The practice regularly worked with other health care professionals in the case management of vulnerable patients. Meetings were held quarterly with the multi-disciplinary team which was led by the care coordinator to review patients progress and to enable continuity of care.
  • The practice informed 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 in normal working hours and out of hours. Patients records alerted staff to when a patient was at risk. The practice had a high number of patients on their at-risk register.