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Gordon Street Medical Centre Good

Inspection Summary


Overall summary & rating

Good

Updated 18 March 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Gordon Street Medical Centre on 5 February 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. Information about safety was recorded, monitored, appropriately reviewed and addressed.
  • Risks to patients were assessed and well managed, including those relating to recruitment checks.

  • Patients’ needs were assessed and care was planned and delivered following best practice guidance. Staff had received training appropriate to their roles and any further training needs had been identified and planned.

  • Data showed patient outcomes were in line with or above those locally and nationally.

  • Feedback from patients about their care was consistently and strongly positive.

  • Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment.

  • Patients said they found it easy to make an appointment and that there was continuity of care, with urgent appointments available the same day.

  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients.

  • Information about services and how to complain was available and easy to understand.
  • 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.

However there were areas of practice where the provider should make improvements:

  • Ensure coding within patients records is accurate and the use of exception reporting is in line with guidance to ensure patients outcomes are appropriately reflected in data.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Inspection areas

Safe

Good

Updated 18 March 2016

The practice is rated as good for providing safe services.

  • There were systems in place for reporting and recording significant events
  • When there were unintended or unexpected safety incidents, patients received reasonable support, truthful information, a verbal and written apology and were told about any actions to improve processes 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.
  • Risks to patients were assessed and well managed.

Effective

Good

Updated 18 March 2016

The practice is rated as good for providing effective services.

  • Data showed patient outcomes were at or above average for the locality.
  • Staff assessed needs and delivered care in line with current evidence based guidance.
  • Staff had the skills, knowledge and experience to deliver effective care and treatment.
  • Staff worked with multidisciplinary teams to understand and meet the range and complexity of patients’ needs.

Caring

Good

Updated 18 March 2016

The practice is rated as good for providing caring services.

  • Data showed that patients rated the practice above 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 also saw that staff treated patients with kindness and respect, and maintained confidentiality.

Responsive

Good

Updated 18 March 2016

The practice is rated as good for providing responsive services.

  • The practice worked closely with other organisations and with the local community in planning how services were provided to ensure that they met patients’ needs.
  • Patients could access appointments and services in a way and at a time that suited them. Telephone consultations were readily available and home visits were provided to house bound patients including the phlebotomy service.
  • The practice offered extended hours from 7am Wednesday mornings to enable patients to access appointments outside of normal working hours.
  • The practice implemented suggestions for improvements and made changes to the way it delivered services as a result of feedback from patients.
  • 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. Learning from complaints was shared with staff and other stakeholders.

Well-led

Good

Updated 18 March 2016

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

  • It had a 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 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
  • The practice proactively sought feedback from staff and patients, which it acted on.
Checks on specific services

People with long term conditions

Good

Updated 18 March 2016

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.
  • Where appropriate patients with more than one long-term condition were able to access a joint review to prevent them having to make multiple appointments.
  • All these patients had a named GP and a structured annual review to check that 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.

Patients with COPD and Asthma had self-management plans, access to medication at home for acute exacerbations and were directed to a structured education programme.

Families, children and young people

Good

Updated 18 March 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 high for all standard childhood immunisations.
  • 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.
  • The practice was able to provide a contraceptive service including contraceptive implants.

We saw good examples of joint working with midwives and health visitors.

Older people

Good

Updated 18 March 2016

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.
  • It was responsive to the needs of older patients, and offered home visits and urgent appointments for those with enhanced needs.
  • The practice embraced the Gold standards framework for end of life care. This included supporting patient’s choice to receive end of life care at home.
  • The practice worked with the Age UK liaison worker to help meet the needs of patients and carers.

Working age people (including those recently retired and students)

Good

Updated 18 March 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.
  • The practice was proactive in working with other providers to provide services in house such as dermatology and podiatry services. This enabled patient’s access to services locally which they would otherwise have to travel.
  • The practice offered extended hours from 7am Wednesday mornings to enable patients to access appointments outside of normal working hours.
  • The practice participated in the Tameside and Glossop seven day access service in which patients could be booked appointments out of hours and weekends with a GP in the local hub.
  • 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)

Requires improvement

Updated 18 March 2016

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

  • 100% of patients diagnosed with dementia had had their care reviewed in a face to face meeting in the last 12 months. We noted however 22.7% were exception reported, 16.5% above the local average.
  • 100% of patients with poor mental health had a comprehensive care plan documented in the record agreed between individuals, their family and/or carers as appropriate. We noted however 74.25% were exception reported, 58.85% above the local average. We raised this with the practice. The practice reviewed the data and we were told there had been some errors in coding patients records and provided us with in year data (2015/16) which showed 14 of the 23 patients had care plans in place either via the community mental health team or GPs. Five other patients although no formal care plans were recorded information was being shared between professionals involved in patients care. We were told improvements would be made in the system to ensure patients data and care was recorded appropriately in future.
  • The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.
  • It carried out advance care planning for patients with dementia.
  • The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations. The practice promoted the local “Healthy Minds” service.
  • It 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 18 March 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 those with a learning disability. Annual reviews were provided for patients with learning disabilities. The practice nurse provided a learning disabilities specialist clinic, inviting patients and their carers where appropriate. The practice nurse worked closely with the local authority learning disabilities team in meeting the outcomes for patients.
  • The practice regularly worked with multi-disciplinary teams in the case management of vulnerable people.
  • The practice worked closely with a local hostel for women fleeing domestic violence, often registering patients and children at short notice using a PO BOX address to maintain confidentiality and the safety of patients. They practice also worked alongside a supported accommodation provider, enabling people living in the supported accommodation to register as patients. The practice was proactive in meeting patients often complex needs.
  • 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 in normal working hours and out of hours.